Over the past few years, discussions of automation acquisitions often revolved around making choices: tight budgets forced the prioritization of spending, the result being more gradual adoptions of new technologies. As budget constraints are easing, the depth of implementations now marks the most successful operations. For example, those able to retrieve in-depth usage data in near real time are best able to drive practice changes that increase the efficient and effective delivery of patient care.

Focusing on the depth of technology usage and gathering ongoing data to ensure continuous quality improvement (CQI) processes are fundamental to ensuring the highest return on investment for your automation dollar. In that quest, it is key to have sufficient staff—both in terms of training and in numbers—to ensure automation implementations deliver connectivity along with effective data in report formats that can be easily accessed and utilized. Too often, pharmacies operate without sufficient pharmacy informatics staff. Yet it is clear that the facilities with the highest automation rates and the highest satisfaction levels with their technology have pharmacy directors that are quite involved in the purchasing process and are also well-supported by specialists with pharmacy informatics expertise. 

Survey Design
In the second quarter of 2013, Pharmacy Purchasing & Products polled a random, nationwide sample of health system pharmacy directors. We asked about automation budgets, informatics staffing, current automation use, and future plans for technology adoptions. Responses were solicited via email and a total of 465 pharmacy directors replied, yielding a confidence interval of 4.36 (95% +/-4.36) based on the population of pharmacy directors nationwide. The results of our survey are shared on the following pages.

We intentionally survey a random sample of pharmacy directors, not simply readers of PP&P, to ensure the data reflects trends across the entirety of US hospital pharmacy practice. Given this, we are quite pleased that almost nine out of 10 pharmacy directors rely on PP&P when researching automation purchases.

Investment Prioritization
Automation budget prioritization has been interesting to observe, particularly as budget reductions have receded. The vast majority of facilities have focused their implementation energies first on CPOE, followed closely by smart pumps, with BCMA in third place. This year both CPOE and smart pumps passed the three-quarter mark for implementations, while just 65% of facilities have BCMA in place; this progression of investment has held true across facilities of all sizes. Much of this automation growth was made possible by the breadth of wireless network implementations that have laid the groundwork for increasing automation connectivity. 

CPOE and smart pumps joined automated dispensing cabinets (ADCs), unit dose packaging operations, and finance integrity systems—three technology solutions that were already established in more than three-quarters of all facilities nationwide. We expect automated temperature monitoring implementations to join this illustrious group next year as facilities are rapidly leaving their manual systems behind in favor of this more efficient technology. 

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Projected Budget Expansion
Just as budget decreases are becoming a hallmark of the past, static budgets also are being replaced by budget growth. This year was defined by increases in pharmacy automation spending over last year for many facilities, and that trend is projected to continue; over the next five years, more than half of all facilities expect to enjoy automation budget increases. 

Depth of Automation Use Improves
As expected, the largest and most well-funded facilities tend to lead in new technology adoptions. As these facilities enjoy the success of their increased interconnectivity, other facilities naturally seek to follow suit. Over the next few years, small to mid-sized facilities are likely to lead in the number of new implementations in some categories, including CPOE and automated temperature monitoring. 

The widespread use of automation in pharmacy is creating interesting new dynamics. Not surprisingly, pharmacy’s level of involvement in selecting and implementing new technology has a clear correlation to ultimate product satisfaction. Those facilities maximizing the interconnectivity of their technology also report higher product satisfaction. For example, when ADCs are profiled and bar code verification is incorporated into the restocking process, those facilities report higher satisfaction with their cabinets. In addition, satisfaction ratings for smart pumps increase when the pumps are interfaced to a BCMA system. 

However, tension may accompany the goal of maximizing value from a technology investment, as increasingly sophisticated data analysis to drive CQI may not always be easily accessed with current tools. Smart pumps are an excellent example of a popular product that simultaneously receives many complaints regarding data collection capabilities. Similarly, those using CPOE systems with limited data integration capabilities are frustrated by the challenge of taking full advantage of this electronic communication.

Technology Satisfaction
For two years in a row, automated drug storage and retrieval systems have maintained their first place ranking among pharmacy automation solutions in terms of user satisfaction, followed closely by ADCs. Automation that assists in ensuring the accuracy of compounded products, while easing workload, also receives high rankings. This is good news for those considering managing more of their compounding in-house. Likewise, pharmacy directors value the efficiency and accuracy afforded by smart pumps during the drug delivery process.

Top-Rated Automation Solutions in User Satisfaction

1. Carousel/Robot Storage 
2. ADCs
3. Automated Compounding Devices
4. IV Workflow Management Tools
5. Smart Pumps

Notably, the automation solutions that received the lowest satisfaction ratings remain unchanged from last year; pharmacy directors indicate there is room for improvement with both unit dose packaging solutions and CPOE systems. Likewise, satisfaction is low with current data collection processes for smart pumps. As these products mature and future software upgrades are released, we will be watching for satisfaction improvements in both CPOE and smart pump data collection ratings. The solution to improving unit dose packaging satisfaction will likely be more elusive, as this frustration is driven primarily by a persistent inability to purchase all medications in a uniformly bar coded, unit dose format from the manufacturer. 

Frustration continues to accompany the medication reconciliation process, although those facilities that have automated their process have seen improvements. Nonetheless, there is no panacea to ensure thorough, accurate records will be received and then continually travel with the patient in our current system of incomplete and often fragmented data.


Expanding Automation
On the pages that follow, we detail the changes that occurred in pharmacy automation throughout 2013. Some categories are particularly notable when reviewing the growth that defined this year. 

• CPOE continued to experience phenomenal gains in implementation rates, a trend that is projected to be sustained as the next few years will also be marked by rapid uptake in CPOE adoptions
• Outsourced repackaging operations developed increasing efficiencies; more facilities are dispensing the bulk of their medications in bar coded unit dose, even though availability of this format from manufacturers has only improved incrementally
• Automated compounding devices also saw an uptick in adoptions this year among the largest facilities, and as facilities continue to evaluate their compounding options, we will be watching this product class closely
• ADC usage is not only widespread, but also is becoming more sophisticated. This year’s survey found that ADCs were more likely to be used as the primary means of drug dispensing, more likely to be profiled, and more likely to utilize bar code verification during restocking
• The move toward point-of-care distribution continues to underpin many technology adoptions. Facilities adopting this popular distribution model are more likely to implement CPOE, have higher ADC usage rates, and are more likely to have BCMA in place
• The importance of focusing on drug distribution also is evident in the OR. Drug distribution in this setting is increasingly monitored by pharmacy—crash cart usage is diminishing while standard and OR-specific ADCs are quickly becoming the norm
• The desire to automate historically manual processes is strong throughout pharmacy operations of all sizes. Interest is high in automation options for waste management; as a result, manual programs are becoming passé, and an inclination to adopt new automation options, particularly to manage the challenge of controlled substance disposal, is developing 
• Outpatient operations are increasingly popular, and although they have historically been concentrated in larger, urban facilities, they are now expanding into less densely populated areas. The rewards reaped as a resultof providing outpatient services are evidenced as most hospitals plan to expand their current outpatient services

In Conclusion
The path toward adopting new pharmacy technologies has been well planned by many facilities. Challenges arise in ensuring the best technology fit for your operation and delivering a strong return on investment. Those facilities that report the highest success in these areas typically rely on pharmacy informatics staff to aid in this endeavor. PP&P will continue to share their success stories with you, as well as their lessons learned, in the year to come.

Deanne Halvorsen is the editorial director at Pharmacy Purchasing & Products and can be reached at dhalvorsen@ridgewoodmedia.com

For your convenience, many of the graphs on the following pages are available as PowerPoint slides on our website (www.pppmag.com/slides). You are welcome to use this data (with the appropriate credits) in your presentations to demonstrate operational efficiency, bolster your acquisition efforts, or simply benchmark your automation progress.