At Wake Forest Baptist Health, A Fully Autonomous Pharmacy Vision

Oct. 1, 2019
Hospital and health system pharmacies have been examining how they can turn a variety of manual processes into automated ones

With some estimates pointing to more than $450 billion annually being spent on medication management across the continuum of care—and pharmaceutical costs increasing 10 times faster than hospital revenue—pharmacy leadership across the healthcare ecosystem is increasingly under great pressure to improve outcomes and reduce costs.

One healthcare solutions company doing innovative work in this space is the Mountain View, Calif.-based Omnicell, which recently announced a new professional services portion of its business to help their hospital pharmacy customers get greater transparency into supply, medication expirations, and where physical products are stored.

According to company officials, “The Autonomous Pharmacy is a roadmap designed to develop a zero error, fully automated medication management infrastructure that empowers pharmacists, nurses, clinicians, and pharmacy staff to focus on patient and clinician satisfaction, leading to improved patient care, fewer errors, enhanced safety, and new opportunities for growth. Every dose of medication is considered a digital node in the network across the continuum of care. Through a series of autonomous workflows, powered by Omnicell’s cloud data platform, pharmacy leadership has access to rich data insights and optimization recommendations to address clinical, operational, compliance, and population healthcare challenges.”

In Winston-Salem, N.C., leaders at Wake Forest Baptist Health, an academic medical center, and customer of Omnicell, are driven to automate the medication use process since they believe it improves drug dosing safety and also gives its team access to more actionable data, explains Jennifer E. Tryon, Pharm.D., associate vice president and chief pharmacy officer at Wake Forest Baptist Health.

When thinking about pharmacy practice in a health system setting, folks likely envision patients coming to a community pharmacy and picking up a prescription that they could be on for maintenance purposes, or that they got after a clinic visit. And while those services are part of what Wake Forest Baptist Health offers—it has retailer community pharmacies in the health system practice—it also distributes medications to the floors of hospitals, and has pharmacists who round up on the floors with care teams. The medical center also runs infusion centers with hazardous and high-risk medications, and has pharmacists who see patients with chronic illnesses, notes Tryon.

Given all that, when it comes to the medication use process in a health system setting, there are many different points along the way, and Tryon and her team have set a goal of having 100 percent of medications go through automation. She offers an instance of one of the system’s 900-bed hospitals waiting for a technician to deliver a medication, leading to delays and ultimately patients having to wait for their prescription.

“When we think of automation, typically it hits in certain parts of the medication use process, but there isn’t anything that hits along the entire process, with analytics to help support it, and that gives us transparency into our processes, workflows, and high-cost medications. So the autonomous pharmacy vision addresses all of those issues and concerns that exist in a very manual process today,” Tryon says.

What Autonomous Pharmacy Entails

Tryon’s vision is a fully automated medication distribution process—inclusive of everything from ordering the medications to the time they are administered to being able to track every step along the way in that process. However, Tryon, says, “The autonomous pharmacy vision is so much more than that,” because it layers on top an intelligence piece so that the data is available in real time and is pushed out to pharmacists, providers and others through dashboards. This enables, for instance, a technician who is working in a space with a safety issue to see this information in real time and make the necessary adjustments.

How does the autonomous pharmacy vision look in a healthcare system setting? One example is via controlled substance management, which is a highly-regulated environment, Tryon notes. Since pharmacy IT systems do not always “talk” to electronic health record (EHR) systems—in regard to where the medications are ordered, documented as administered, as well as the information that’s pulled out of Omnicell’s dispensing cabinets that house the medications—“risky” situations that could potentially jeopardize safety arise.

“Typically, there is a lot of manipulation of the data, but with the autonomous pharmacy [vision], that information would be readily available so that whoever is managing that space would know to look into a potential issue. And there would be artificial intelligence associated with this so that it would be a learning system, and if someone was flagged before, that information would come forward,” she explains.

What’s more, for medication distribution, Tryon points to the number of resources that are needed just to make a medication available for a patient. “That process is very manual with lots of different steps and human touch points,” she says. But with the autonomous pharmacy vision, “the plan is to have that happen seamlessly and in a highly-automated fashion, which would allow us to redeploy our resources—technicians and pharmacists—to do what they are trained to do, which is take care of patients and perform as members of the interprofessional team,” she adds.

To this end, the feedback from pharmacists has thus far been “extremely favorable and has allowed us to prioritize our work around the biggest medication management problems of the day, enabling us to be where the patients and our teams need us most,” says Tryon. And that can range from helping to dose a medication for a critically ill patient to making sure they are addressing a patient’s social determinants of health [SDOH] for when that patient either cannot get or afford medication. “We want to make sure that we can address that with them as partners—ensuring that patients have medications in their hands so they don’t get sick again and find themselves back in the hospital setting.”

The SDOH element is one of the least studied areas of pharmacy, and while Wake Forest Baptist Health has striven to improve here, it can be difficult to capture that data and link it to patient outcomes, Tryon notes.

“We do have reports that we run on different SDOH categories so that we could have interactions with patients and try to better understand their needs, but we need 10 times the amount of people we currently have to meet the population that needs our help,” Tryon acknowledges. “And when we achieve the autonomous pharmacy vision, that will allow me to reallocate resources—who today may be checking products or may be linked to doing chart reviews—to proactively examining how we can best address the patient’s needs. From a population health standpoint, every patient is a little different,” she says.

Going forward, while the core goal is to fully achieve the autonomous pharmacy vision across the health system, Tryon points to more specific instances of where the organization’s leaders expect to see notable improvements:

  •  Dealing with drug shortages—which the health system might have over 100 to manage at any given time. Tryon notes that in some instances, they might have difficulty acquiring alternative medications for their patients, or in other cases there is actually no alternative. “So, in a health system like ours, we bring a group together and run the reports to find out where the inventory is within the system and then figure out where to best deploy those scarce resources to the patients who need them the most,” she says.
  • Greater visibility into the highest-cost medications. One drug that recently hit the market costs more than $2 million per dose, and this is just one example where Tryon believes greater transparency is needed to see where that drug inventory is at, while also having “smart” support to quickly generate new ideas, “rather than constantly recreating the wheel to identify strategies for best managing these high-cost medications,” she says.
  • Adding “a tremendous layer of safety” since automation can be leveraged to do some of the sterile and non-sterile compounding of medications, rather than a technician being in the IV room and pulling data up manually.                                                                                                                                                     

All in all, Tryon refers to the “wicked problems” that have plagued pharmacy operations for decades—issues such as missing medications within health systems, or being unable to reduce waste.

“These are issues we have never been able to have full visibility into, and we don’t have solutions to purge them from our systems. So the autonomous pharmacy vision allows us to purge what we have deemed ‘wicked’ problems,” Tryon contends. “I am very anxious for the day where I can fully deploy our pharmacy team members to care for patients.”

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