Survey Design

In the early summer of 2009, Pharmacy Purchasing & Products polled a random, nationwide sampling of health system directors of pharmacy. We asked about their staffing, budgets, current automation systems, and plans for future implementations. Responses were solicited via e-mail, and we received a total of 396, yielding a confidence interval of 4.75 (95% +/- 4.75) based on the total population of directors of pharmacy nationwide.

We intentionally surveyed a random sampling of directors of pharmacy, not just readers of PP&P, to ensure our data reflects trends across the whole of hospital pharmacy practice. Therefore, we are quite pleased to see that 72% of survey respondents use PP&P as a tool for researching automation purchases.

Budget Crunch

Overall, pharmacy budgets remained flat versus last year, and while some of the smallest facilities enjoyed budget growth, 28% of all hospitals had budgets cuts. Only one third of facilities are expecting budgets increases next year, with the remainder projecting that their budgets will either stay the same or decrease. However, the long-term outlook shows signs of improvement: 59% expect budget increases in the next three to five years. 

Survey Trends

Despite the overall lack of budget growth, pharmacy continues to move toward automating manual systems, however at slower rates of adoption than previously predicted now that DoPs have to spread fewer dollars over multiple implementations. For example, with medication ordering, both physician order management systems and CPOE usage increased this year and more hospitals plan to implement these automated ordering systems in the next few years. In fact, more facilities are currently planning to adopt CPOE than ever before, however the timelines to adoption of these systems is now longer than originally predicted in 2008.

2009 also saw a leveling off of activity in the unit-dose packaging arena—fewer facilities outsourced their packaging and there was no increase in the number of facilities with packaging operations.  This slowdown in activity is expected to be temporary as DoPs looking forward predict there will be an upswing in both the use of outsourced packaging services and implementation of in-house packaging operations.

The move toward decentralized distribution models continues across facilities of all sizes, with the decentralized approach expected to surpass centralized as the most common distribution model in the next year. Reflecting this trend, COW usage is on the rise and there is a simultaneous uptick in interest in automated dispensing cabinets (ADCs).

While ADC implementations increased at a slower pace this year, this technology remains a favorite with DoPs. ADCs receive high user satisfaction ratings and with the exception of the smallest hospitals are used consistently across facilities of all sizes. 

BCMA adoptions continued to grow at a strong rate and interestingly, projected timeframes to implementation have not slowed. Pharmacy’s high level of involvement in selecting and implementing these systems is a contributing factor to their high user satisfaction ratings. Other technologies benefitting from increasing numbers of implementations include smart pumps and wireless temperature monitoring. Furthermore, strong growth for both of these classes is expected over the next few years.

The market segment experiencing the highest rate of growth this year is outpatient pharmacy. Given the positive impact outpatient pharmacy services can have on a health system’s bottom line, it is no surprise that many health systems are committed to incorporating outpatient services.

Challenges for Pharmacy

Despite the many improvements from automating pharmacy processes, there is still room for improvement. For many pharmacies, bar coding syringes and other oddly shaped items continues to be a challenge—we will be watching developing trends in robotic IV syringe prep device adoption, which is currently in the very early stages.

CPOE is another challenging area for pharmacy. While more health systems than ever before are planning to adopt this technology, CPOE’s satisfaction rates reflect the inherent challenges in implementing these complex systems.

Low rates of adoption continue to mark automated solutions to medication reconciliation, with most facilities reporting a lack of budget as the primary obstacle to implementing this technology. Bar code verification during the medication refill process is another technology with low rates of adoption, although most DoPs plan to implement this in the near future.

Top Rated Solutions

DoPs enjoyed even higher satisfaction rates this year with many of their automation solutions. We compared user satisfaction for each class of automation products, and are happy to report that the top product classes in 2009 are:

1. Carousel and Robot Systems

2. Wireless Temperature Monitoring Systems and

Automated Dispensing Cabinets (tied for second place)

3. Automated Compounding Devices

4. BCMA Systems

5. Smart Pumps

There are many well rated, high quality automation options that will deliver a strong return on investment. Interestingly, there is significant overlap between the technologies with the highest satisfaction ratings and those rated most important to pharmacy (See Figure 1).

Pharmacists as Decision-Makers 

It is no coincidence that DoPs report high satisfaction rates in product classes where they also report high levels of involvement in the purchasing and implementation process. Pharmacy continues to be strongly involved in selecting ADCs, smart pumps, BCMA systems, and bar code printers—consequently, all technologies that received high marks for user satisfaction. 

Conclusion

Despite the economic pressures on health systems this year, many automation systems enjoyed significant growth that is expected to continue into the future. As budget planning becomes even more important in your automation adoptions, continue to look to PP&P to provide you with guidance for getting the most out of your automation spending.

Select charts and graphs from the 2009 State of Pharmacy Automation are available as PowerPoint slides for your use.

Download slides (7.4mb) 

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