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Pharmacy Automation & Robotics Technology Q&A | Miriam Cho, President/CPO, MAC Rx

Q. What are the greatest benefits of pharmacy automation?

Utilizing automation in the pharmacy allows for the ability to efficiently manage workflow, control labor costs, improve accuracy related to human error, and provide relief to current operational concerns related to the current labor market.

Q. When should you consider automation?

Planning and understanding your market and business goals, as well as pre-marketing business growth analysis will help guide the decision between pre-pack and on-demand automation. We have successfully utilized pre-pack automation in the early stages of pharmacy start-ups, added on-demand automation in more mature pharmacies, and also have used on-demand automation in new startup pharmacies where we knew an advantageous ROI would be achieved based on prescription output. With such a wide variety of available products on the market, automation can always greatly assist in reducing pharmacy costs and gaining workflow efficiency for any and all pharmacies.

Q. What are the top resources to find the best types of automation available?

Meeting manufacturers at industry conventions, online resources such as RXinsider, reaching out to other industry colleagues, and also discussing eligible options with your GPO are a few key ways to determine what may best fit your needs.

Q. How do you calculate the impact of automation ROI?

We have traditionally taken a more simplistic method of calculating ROI, using the payback method (number of years to pay off the automation). As an example, in a current project, the cost of the robot is $1.5M, whereas our savings of labor reduction annually is $836K, equaling 1.79 years to pay off the automation and then reach profits. Typically, it is our opinion that anything under 1.8 to 1.5 years is very achievable and advantageous with the right automation.

Q. What is the most challenging aspect of beginning automation in the pharmacy?

It is my opinion and based on today’s market environment, the timing commitment of capital expense and cash flow is the largest hurdle many pharmacies have to overcome. But, once the decision to move forward is realized, assembling a project team and timeline of all goals with date centric achievements to “go-live” is most critical. Manufacturers typically assist in a project driven timeline, which allows for key tasks during the implementation process to not be overlooked. A project team of key leaders in the pharmacy with ongoing meetings is also critical for accountability, to ensure that all tasks are handled, and that any hurdles are actively being managed and eliminated.

Q. Do you believe automation in the pharmacy impacts morale?

We have found automation to have a huge positive impact on morale in the pharmacy. Typically, pharmacies without automation struggle with work flow; one example being dispatch times. Once automation is implemented, we have found the workload to be greatly reduced on manual filling, out times to be achieved, and overall success on service and reduction in costs to exceed expectations. However, messaging is key prior to deployment, as reductions in force may cause some employees to believe they are being replaced causing uneasiness. Over time, the benefits will outweigh all this and be realized by all team members.

Q. How do you measure the efficiency of the automated systems/devices?

The value of metrics and key performance indicators are something that we embrace with great passion. In doing so, we always revert back to the ROI.

We continue to examine and measure:

The performance achieved vs. what we envisioned.

If we are achieving our goal output.

If the automation has been able to achieve the prescriptions per hour and prescriptions per day while maintaining the low error rate we desired.

The percentage of total prescriptions produced by automation.

The impact on dispatch times.

All of the metrics related to buying the automation is monitored through ongoing dashboards and shared with the entire team, to ensure we are reaching our goals.

Q. What is the verification process like when dealing with pharmacy automation?

There are many regulatory compliance considerations here, but suffice to say that many efficiencies may be gained with automation to reduce human intervention therefore gaining the efficiencies set forth in the ROI. Although the actual verification process may remain the same post installation of automation, the ability to implement and utilize a technician product verification program can provide a positive impact to your ROI. Having said this, it is absolutely critical to understand your individual State Board of Pharmacy rules and regulations prior to making this process change. Automation based on the ROI metrics should always increase efficiency of both the fulfillment technician and staff pharmacist roles in the verification process.

Q. What is the error rate of this technology compared to regular human error in the pharmacy?

With most automation that we have utilized, error rates are greatly reduced when comparing automation to human error.  It really depends on the automation, but with the right automation partner, accuracy can substantially be increased when deploying automation in your pharmacy. Automation also shows up on time and does not have days off, unless of course there are maintenance issues.

Q. How efficient are automated devices in the pharmacy when compared to pharmacy technicians?

Depending on the throughput of the automation, a wide range of efficiency can be gained when comparing output of the automation to technicians. It would be recommended to refer back to the drill down details of the ROI, as packaging type, speed of the robot, etc., may all play a factor in efficiency. As an example, one large robot we are purchasing would have an output of 26 technicians over a month period while simultaneously reducing potential error percentage.

Q. How often does technology change where automation would become outdated?

Typically, we believe and plan that automation we purchase will have a useful life of seven to 10 years maximum.

Q. Are maintenance plans worth the additional cost?

It is our belief that maintenance and service plans are critical to automation success. There is no substitute to having 24 hours a day, seven days a week, 365 days a year coverage when the machine unexpectedly fails, not to mention ongoing, regular maintenance is a must. Inevitably, all equipment will eventually have a breakdown or issue due to wear and tear. It is for this reason, we require service plans to have emergency assistance available from the manufacturer with stat timelines of two to four hour service, and also work with the manufacturer to ensure parts are easily accessible by their technicians either in our city or the region. Downtimes can become problematic, so ensuring stat services and maintenance on the front end of the purchase is of the utmost importance.



Miriam Cho, PharmD, President/CPO, MAC Rx

Miriam received her doctorate of pharmacy from Midwestern University and has 15 years of pharmacy experience both in the retail and LTC space. She joined the MAC Rx team in 2015 and assumed the pharmacist in charge role in October of 2015. Since that time, the pharmacy has tripled in size due in large part to her keen sense of pharmacy operations along with her ability to build strong vendor and client relationships. Miriam currently oversees pharmacy operations in over 160 LTC communities. She is recognized as an LTC subject matter expert and is a highly sought-after speaker at national conventions such as the IQ Conference for Red Sail Technologies, MHA, and SoftWriters.

Miriam is a member of the Advisory Board for CAPSA Healthcare, has done extensive work with SoftWriters for development, testing, and legal advisement for new product development, and implemented the first successful transition to perpetual inventory for Framework LTC. She continues to give back by precepting and mentoring pharmacy students by providing them with exposure to this vital segment of pharmacy.

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