Innovation extends beyond the laboratory and treatment rooms at St. Jude Children’s Research Hospital, with the institution implementing Tennessee’s first outpatient pharmacy dispensing kiosk for pediatric patients. This state-of-the-art kiosk, launched in late 2023, highlights how forward-thinking technology can transform patient care and offers patient’s families the convenience of directly retrieving medications at their St. Jude housing facility.

St. Jude is a premier basic science research center and one of the largest centers in the world for research and treatment of pediatric cancers and other catastrophic diseases of children. The hospital’s mission is “to advance cures, and means of prevention, for pediatric catastrophic diseases through research and treatment.” The department of pharmacy and pharmaceutical sciences, a clinical and academic department within the institution, contributes to this unique institutional commitment by providing advanced practice pharmaceutical services that individualize care for each child at St. Jude, while also supporting a collective research endeavor.

The idea of a kiosk emerged from a simple yet powerful idea: Eliminate unnecessary trips to the hospital to allow families to focus on their children rather than logistics while receiving care at St. Jude. Throughout the selection and implementation process, the project team encountered and overcame numerous challenges, ultimately establishing valuable insights for those who elect to implement this technology in other outpatient settings.

Selecting a Vendor

Several important questions must be addressed prior to selecting a system. Compared to most automation implementations, support contracts for medication dispensing kiosk technology are less expensive as there are fewer physical units despite the complex workflow. However, response time needs to be quick in a downtime scenario or patient care will be impacted and it is necessary to plan accordingly. It is important to focus on how the technology will operate within the facility’s existing ecosystem and integrate with the outpatient pharmacy software. Additionally, the vendor’s response to optimization requests will drive your user experience.

Available integration points will have a big impact on vendor selection, and a product that includes a bidirectional HL7 interface with the EHR to enable real-time pickup status is key. While most vendors offer EHR integration, all implementations will require some attuning to specific facility workflows—ask what configuration/customization will look like during any request for proposal (RFP) efforts and if any additional cost is involved. Cloud-hosted solutions may offer straightforward pathways to implementation, scale well to additional sites, and often incorporate single-access sign on. Orders and Admit-Transfer-Discharge (ADT) interfaces can be used across multiple sites as well—be sure to ask if there is an additional cost for these add-ons. When contracting with a kiosk vendor, think about potential future needs and consider future replacement devices when your operation evolves.

Implementation Planning

The first domicile selected for implementation was the Dominoes Village Center, a housing facility for St. Jude patients and their families located on the main hospital campus, but at a distance from the outpatient pharmacy. With construction underway, the facility timed kiosk implementation to the domicile’s planned opening in 2023, as the project team recognized the potential to save families valuable time by integrating pharmacy services into the housing environment. The initiative aligned with St. Jude’s strategic goal of setting new standards in patient care and experience and it reflected the institution’s comprehensive approach of prioritizing both medical outcomes and the day-to-day well-being of patients and their caregivers.

From the outset, the kiosk project required detailed planning and coordination across several departments, including pharmacy operations, pharmacy informatics, information services, environmental services, design and construction, housing services, and patient experience teams. Each group focused on how the kiosk could help achieve improved patient experience and satisfaction.

Early planning involved securing approval from the Tennessee board of pharmacy and navigating the logistical and regulatory nuances of implementing a remote medication dispensing solution. Of note, this solution is currently used for dispensing non-refrigerated and non-controlled substances only, due to state board of pharmacy requirements. For the same compliance reasons, prescriptions are dispensed with English-language directions and inserts only.

Navigate Challenges

The first challenge to consider is how to handle system integration. Thoughtful integration with the existing EHR system is required. This includes configuring the outpatient EHR to support workflows specific to the kiosk, such as assigning medications, verifying chain of custody, and ensuring compliance with all safety protocols. Some initial challenges with system compatibility highlighted the importance of robust end-to-end testing prior to going live: the vendor can be helpful in this process, but ultimately, thorough end-to-end workflow mapping is necessary to identify any bugs in the organizational processes before going live.

Security and compliance measures can be another hurdle. Ensuring medication safety and compliance is paramount. The kiosk features tamper-evident packaging, barcode verification, and dual-camera surveillance. These layers of protection require coordination between pharmacy operations, information security, and compliance teams to align physical and digital safeguards and to support the waiver from the board of pharmacy.

Finally, while common to large scale projects, procurement and construction delays posed a potential setback. The team mitigated this risk by building flexibility into the project timeline and preparing contingency workflows to maintain momentum during delays. We found that much of the kiosk workflow could be tested without the kiosk in place, and it was relocated to a temporary area of the institution for testing in response to continued construction delays.

Develop Streamlined Workflows

A critical component of success is designing workflows that enhance efficiency without creating confusion. The pharmacy team developed step-by-step protocols for loading medications, notifying caregivers, and enabling remote pharmacist counseling. The team validated each step through simulations to identify potential bottlenecks or risks.

Early on, staff realized that the kiosk’s video counseling feature, essential for compliance, required a user-friendly design. Training pharmacists to navigate video interactions smoothly ensures that counseling sessions are as seamless as in-person discussions. On the order entry side, an easy to follow workflow was created for prescribers to choose the kiosk; once implemented, prescribers can select “Kiosk,” which then sorts those prescriptions to twice-daily batch fills from the outpatient pharmacy specifically designated for delivery to the kiosk.

Workflow Planning Insights

The success of this initiative depends on a collaborative planning effort. Breaking down silos and fostering collaboration among diverse stakeholders, from pharmacy staff to IT and facilities teams is crucial. Early alignment on project goals ensures that every department is working toward a shared vision. We found having a dedicated project manager for this effort delivered significant benefits.

Flexibility in the design is another important factor. Choosing a vendor whose technology can adapt to unexpected challenges is invaluable. For instance, the kiosk integrates with backup power supplies and cloud-based monitoring to ensure uninterrupted service during technical or environmental disruptions. Thus, patients can pick up their prescriptions even during downtime.

As with all new technology, user training cannot be overlooked: pharmacy staff and patient families need clear guidance to use the kiosk effectively. Comprehensive training materials, including video tutorials and quick-reference guides, are instrumental in minimizing errors and building confidence. This is particularly important when establishing prescribing workflows; providers benefited from an easily accessible tip sheet in the weeks following the go-live.

One of the several benefits of the kiosk is the data driven decision making capabilities it offers. Daily transaction and inventory reports provide real-time insights into kiosk performance. These metrics enable the team to quickly identify and resolve issues, such as optimizing medication loading schedules to match peak pickup times. The time that medications are loaded into the kiosk was changed shortly after going live in response to these trends.

Finally, consider how patient feedback can be used to shape success. We found that families’ input played a pivotal role in refining the kiosk experience. Survey responses drove how notifications would alert patients to prescription availability and location when medications could not be accessed from the kiosk and highlighted the importance of convenient notification systems and intuitive interfaces, leading to enhancements such as automated text alerts and simplified touchscreen navigation. The outpatient pharmacy team made a concerted effort to engage patients upon their first use, to ensure all questions were answered and feedback was collected to update workflows early on.

Benefits and Opportunities

Implementing this kiosk relieves an additional burden for families receiving care, allowing them to pick up their prescriptions and be counseled by a St. Jude pharmacist on their own time. Patient satisfaction scores reflect the value of eliminating wait times at the hospital pharmacy, while caregivers report greater peace of mind knowing that medications are just a few steps away. These outcomes validate the project’s core goal: to make life easier for families navigating pediatric cancer treatment.

For St. Jude staff, the kiosk has introduced efficiencies in workflow and inventory management. Real-time tracking ensures accountability, reduces errors, and supports the institution’s broader commitment to operational excellence.

The project also revealed challenges that underscore the need for ongoing oversight; for example, ensuring the kiosk can handle high demand during busy times, such as after clinic hours. Technical concerns, such as occasional delays in syncing data between the kiosk and the EHR, highlight the importance of continuous IT support and updates. Another area for improvement involves tailoring the kiosk’s user experience to better meet the needs of patients with varying levels of digital literacy, ensuring it is accessible to all families.

Perhaps most notable is the current inability to dispense controlled substances and refrigerated medications due to our state’s strict regulatory requirements. Most states have not yet developed laws around kiosks; as such, it is important to work with the board of pharmacy to ensure compliance. This can impact patient uptake of the technology, as patients prefer to pick up all of their medications at once; removing regulatory hurdles will be critical for the expansion of this technology. These challenges, while significant, present opportunities to refine and expand the service.

Future Directions

Building on the success of the medication pickup kiosk, the pharmacy department is exploring opportunities to replicate this model in other St. Jude housing facilities in Memphis. As we continue to enhance this process, we will rely on the lessons learned from the initial implementation to guide our future efforts, focusing on improving scalability and further integration into clinical workflows.

Implementing the kiosk is not just a technological achievement–it is also a testament to what can be accomplished when patient care is placed at the center of technology, safety, compliance, and workflow planning. The prescription pickup kiosk exemplifies St. Jude’s pursuit of innovation and excellence. By reimagining pharmacy services, St. Jude demonstrates its commitment to improving the lives of patients and their families.

David Aguero, PharmD, MSTL, FAMIA, FASHP, is the director of medication systems and informatics as well as the program director, PGY2 pharmacy informatics, at St. Jude Children’s Research Hospital in Memphis, Tennessee. In his role at St. Jude, David is responsible for the leadership of medication-use systems and supporting technologies including informatics, pharmaceutical analytics, and supply chain service lines.

Steve Pate, DPh, is the deputy chief pharmacy officer, senior director of St. Jude Children’s Research Hospital. He received his bachelor of science in pharmacy from the University of Tennessee College of Pharmacy.