We are entering a new era. The past decade has been marked not just by the market crash of 2008, but also by the restraint that accompanies a stagnant economy. 

The most damaging impact of stagnation is the absence of innovation. For many companies, the funds that normally would be dedicated to supporting new ventures or launching novel products were relegated instead to daily operations. When risk taking is replaced by the need to conserve resources, creativity suffers. 

Innovation is the hallmark of any recovery, and one of the many positive trends we see in this year’s State of Pharmacy Automation survey is the increasing adoption of novel automation solutions by hospital pharmacy. Not only have facilities of all sizes committed to ensuring a baseline of automation expertise— through the implementation of CPOE, BCMA, and smart pumps—but a growing number of facilities also are introducing new technologies to address thorny issues, such as managing controlled waste responsibly and automating the typically manual filling and bar coding of unique syringes. 

Survey Design
In the second quarter of 2015, Pharmacy Purchasing & Products polled a random, nationwide sample of health system pharmacy directors. We queried these pharmacy leaders as to their current expenditures on pharmacy automation, as well as future budget projections. In addition, we asked about current automation usage, staffing levels, and future automation expansion plans. Responses were solicited via email, and a total of 374 pharmacy directors replied, yielding a confidence interval of 4.9% (95% +/-4.9) based on the population of pharmacy directors nationwide. The results of our survey are shared on the following pages.

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

Expanding Budgets
Projections for strong pharmacy automation budget increases, coupled with a large pool of graduating pharmacists and a significant decline in the amount of uncompensated care provided by health systems, bode well for the expansion of pharmacy technology over the next few years. Budget reductions no longer threaten the stability of pharmacy departments; rather, most health systems are looking forward to expanding their pharmacy automation expenditures. Likewise, a growing number of facilities have added pharmacy informaticists or automation specialists to their staff to help guide this expansion. As demonstrated in the survey results, facilities with dedicated pharmacy informaticists tend to be leaders in automation adoption and are more satisfied with their automation choices. 

Top User Satisfaction Ratings

1. Automated Dispensing Cabinets
2. Automated Compounding Devices
3. Outsourced Repackaging
4. Carousel/Robot Storage
5. Bar Code Verification Devices

The technologies with the highest user satisfaction ratings are notable this year for their variety. From medication preparation and storage to delivery and verification, pharmacy depends on many highly rated products to deliver safety and convenience. Not only are automated dispensing cabinets (ADCs) the most widely implemented automation solution in hospital pharmacy, they also retain their high user satisfaction rankings year after year. Another solution with a long history of highly satisfied users is the automated compounding device category. This is good news for those facilities looking to apply a systematic, bar code-driven approach to their compounding operations. 

One area that remains a point of frustration for pharmacy is the ongoing need to manually repackage products. While manufacturers are providing an increasing number of products in unit of use, manual repackaging is not only difficult to eliminate, it was increasingly common this year. In the drive to eliminate time-consuming, rote tasks that are prone to human error, many facilities are considering outsourcing their repackaging. Fortunately, these vendors receive high marks from their current users. This also is an area that is benefitting from vendor innovation, as Medical Packaging Inc has introduced a new, automated syringe labeling and filling system that eliminates many of the repetitive manual functions required for preparation. 

Technology Expansion Plans
Over the next 5 years, automation adoption is expected to continue at a strong clip. The technologies that are projected to enjoy particularly high implementation rates are:

1. CPOE
2. BCMA
3. Temperature Monitoring Devices
4. Smart Pumps
5. Medication Reconciliation Software

Historically, the early adopters of new technologies often are large facilities with deep budgets. It is notable that much of the automation expansion this year occurred in small and mid-sized facilities. While the largest facilities still maintain a lead in automation adoptions, facilities of all sizes have made a strong commitment to adopting CPOE, BCMA, and smart pumps, and we expect that trend to continue. Similarly, as temperature monitoring has become an increasing focus of regulatory inspections and vendors have provided easy-to-use solutions, use of this automation is expected to expand quickly across facilities of all sizes. Preventing errors during transitions of care is another focus for pharmacy. Many facilities are looking for software solutions to automate their medication reconciliation processes.

An additional area of projected growth for pharmacy is outpatient pharmacy services. During the economic downturn, interest in expanding pharmacy services through outpatient offerings declined, as many facilities focused their attention (and budget) on existing services. However, this year saw an increase in the number of facilities offering outpatient pharmacy services. Perhaps the greatest endorsement of these services is that the vast majority of outpatient operations plan to expand their offerings over the next 3 years.

Changes in Pharmacy Practice
To ensure that pharmacy staff members are practicing at the top of their licenses, a significant investment of time and training is required for pharmacists, technicians, and support staff to attain their optimal levels within the organization. 

Coupling these efforts with an investment in automation ultimately delivers improvements in patient care and safety. This year’s survey elucidates those areas where pharmacy has enjoyed success and others where more work remains to be done. Some of the interesting developments this year include:

• Pharmacy directors have exhibited a burgeoning interest in medication tracking systems that expand the utility of bar coded products
• The point-of-care distribution model has become the standard; however, switching to this model requires a significant investment in time and resources
• 2D bar codes are increasingly common in the pharmacy, and this expanded data capability may be helpful in meeting the new Drug Supply Chain Security Act regulations. While few facilities use 2D bar codes exclusively, most facilities use this labeling option for at least some of their medications.
• ADCs retain their popularity, with many facilities looking to expand the capacity of their cabinets. ADC monitoring software, which is now in place in a majority of facilities, further supports this effort. 
• Many facilities are now considering the adoption of medication tracking systems to expand the utility of bar code verification, reduce interruptions in the pharmacy, and provide accurate data on current distribution methods. 
• Smart pumps, while widely enjoyed, continue to leave pharmacy directors frustrated in terms of data transfer. For many facilities, transferring data to and from their smart pumps requires significant effort, and few have been successful implementing patient-specific programming. It is worth noting that the facilities that are highly satisfied with their smart pumps have invested in their data-transfer capacity and are programming their pumps with patient-specific data, often from 2D bar codes. Another factor common to these highly satisfied facilities is that the pharmacy directors were significantly involved in the vendor selection process for their smart pumps. 

Involvement in Purchasing Decisions
It is important that pharmacy raise its involvement in purchasing decisions. While pharmacy remains very involved in implementations of key technologies such as smart pumps, CPOE, and EMR, we have seen drift over time with pharmacy’s role in the purchasing process for some of these technologies. When pharmacy is not at the table during the selection process, we see a clear line to lower satisfaction with the vendor. 

Ultimately, pharmacy must be involved with new automation initiatives from the outset in order to ensure the chosen vendor is the best fit for the organization. This involvement also allows pharmacy to have input on the next phase of product development, such as data collection improvements, better reporting options, and improved interfaces. Contrary to what we learned in kindergarten, sometimes the best way to contribute to a solution is to complain. Be vocal about the improvements you would like to see from your vendors. 

In Conclusion
The State of Pharmacy Automation is made possible through the thoughtful commitment of the pharmacy directors who take the time to complete the survey every year and share their automation experiences. We are grateful to you and happy to add your voices to our 10-year compilation of data that demonstrates the great strides pharmacy has made and the work that is yet to be done. The road map is clear and the automation choices are growing. Pharmacy Purchasing & Products will continue to be the voice of pharmacy, sharing the success stories and lessons learned from those pharmacists who are paving the way.

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

 

Many of the graphs on the pages herein are available in our State of Pharmacy Automation slide kit. We are happy to share this resource once again. You can download the slides at www.pppmag.com/slides. As long as you maintain the credit that appears on each slide, you are welcome to incorporatethese slides into your presentations, whether to your peers at national meetings or to your administration in support of expanding pharmacy programs.