Is Central Fill Taking Away My Job?
October 11, 2009 by Bill Bailey, RPh
Filed under Rx Topics
Recently I was filling in a shift at a local retail pharmacy and was listening to a couple of technicians talk about Central Fill coming to their company.
As you can imagine, the first thought that came to their head was “Am I being replaced by a robot?”
Good question, but not likely. Although central fill and automation may offer some core efficiencies, there are a couple of considerations here…
First, most central fills focus on refills. Most pharmacists and technicians realize that “training” the customer to call in a day ahead of time may be a challenge. Unless the central fill is close to the receiving pharmacy, the patient would have to call a day ahead in order to trigger the use of the Central Fill.
The other consideration is this should free up time for the pharmacist to perform more MTM and counseling since they will spend less time checking product.
So the question is, “Will patients conform to calling in a day early to support Central Fill?”
The bigger question is “Will retailers keep the RPh hours to increase counseling, or decrease to reduce Labor costs?
Bill
Dear Editor,
Walking amongst the Robots, Who will Win?
A Pharmacist’s, Call to Action!
You pose very interesting question at the end of your article. That question being, “Will retailers keep the RPh hours to increase counseling, or decrease to reduce Labor costs?
This is a conundrum surrounding the profession of pharmacy for the past few decades. With the advent of chain retail pharmacy and the mass merchandiser intervention in the profession, how has this affected our professional goals and standards? Who currently defines the principles of professional practice? What are the standards that we measure a successful pharmacy intervention or practice? Who will be defining those professional practice standards? Are we a self-determined profession or do we to answer only to those corporate individuals without healthcare training or medical ethics?
The whole argument to justify the capital investment for computerized systems and robots is based on cost reduction. Cost consensuses are a reality and common theme in the modern healthcare arena. Cost reduction is always an attractive outcome in any financial analysis. Assessment of pharmacy services by utilization by phamcoeconomic evaluations is now a common practice. It is obvious that filling prescriptions by robot is less expensive and faster. Therefore, unless we can devise a new way of filling prescriptions faster and cheaper than a machine, we need to reevaluation the situation. We need to change the playing field; this is the most viable option. One thing that is not replicable by modern technology at this point is artificial intelligence. Therefore, we have a distinct advantage over machines, we can use our intelligence to win the race. .
Additionally, to answer some of these questions we might want to look at the direction of recent management decisions by the large corporate Retail pharmacy industry recently, specifically in the last five years. As the old adage goes “Don’t listen to the talk, Watch the Action!. During the last five years, has the Pharmacy industry been encouraging us to engage in more patient orientation and education? How are pharmacists motivated and evaluated by Retail Pharmacy Management? How are we evaluated; By how many therapeutic interventions we make per hour using our Clinical Skill sets in patient therapies or are we evaluated by the same “OLD SCHOOL” set of initiatives of how many prescriptions we are able to produce in a given hour? The answer to this question is obvious. If we use the old school standard of how many prescriptions per hour, we will always lose the race with robots!
When we look for recent changes, do we see any shift towards a change in objectives by the industry? Regrettably, what we do see are very small, insignificant initiatives by the chain pharmacy industry rather than large programs that change the status quo! What really needed is a change in the face (profession) of Pharmacy. But this change will have to start with the professionals themselves, yes US! If we are professionally complacent or content in the existing system, then here is where we will remain. Unless, we as professionals, ask for change we shall not receive it, especially from large corporate executives who are using a completely different ethical and professional rulebook.
Since many of us work for large businesses, we do not have the convenience to define our career paths as professionals. Those who employee us who are responsible for defining our professional lives and how we live them, However, we should be helping to define our vocation. We as professionals need to redefine our mission as professionals and help our employers to do so. Many studies have proven that pharmacy can make a positive difference in positive clinical outcomes. We need only look no farther than the Ashville project and to see the huge successes accomplished by pharmacy interventions across the boards in various chronic disease states
There is a glimmer of hope in the horizon. This optimism comes in the form of the MTM initiative by Congress. Pharmacy as a profession, has the opportunity to become a “true” profession with the advent of MTM by Congress. This is an effort to improve existing Medicare/ Medicaid Services,. Rather than just providing just a distribution role, Congress is asking Pharmacy to become our true professional selves by providing our pharmaceutical care services in areas of patient education and orientation. Congress is proposing reimbursement for such services. This system is under evaluation now by congress.
This is the Pharmacists Call to Action. For many years, Pharmacy as a profession has proclaimed themselves as the “Pharmaceutical Information Experts”, now Congress and a few Insurance companies are willing to pay for these professional services and the amounts are significant. At least in some parts of the country some insurance companies have begun pilot programs to evaluate the feasibility of the idea.
We need to ask; how many of our colleagues are actually engaging these types of activities? Are we as professionals committed to changing the face of the profession or are we willing the take the path of the robots? Are we answering the call of the healthcare industry to the profession? Are we retraining ourselves in order to fit this new more clinical role?
The answer to the question: Will robots replace the profession of Pharmacy? Theoretically, they could, with the initiatives of e-prescribing and large automated systems. Soon, all the health information will be collected in a large computer network for evaluation by the computer system. The prescriber will be in touch with a large health information database. Then the prescription will be forwarded to a pharmacy in the form of e-prescription. That source could be the most inexpensive supplier available which will be a highly automated systems (ie robots) This algorithm will hold true if pharmacy practice is continually evaluated on the standard of prescription output per hour basis. Therefore, we as professionals have to change the way we are evaluated. Additionally we need to add value to our services that or is difficult to replicate by automation. Complex upper level executive thought is one such process that cannot be duplicated in common computer models to date.
Yes, of course, in the distribution role robots are superior. Nevertheless, The more important question is: Will Pharmacy be replace as a professional by automation? The answer depends largely what resides in the hearts of the pharmacists themselves.
John P Banahan, Rph
A independent retail pharmacist for more than twenty five years
Currently working a Director of Hospice pharmacy services in metro San Juan Area.
I am a technician at a central fill, and there seems to be a general lack of information regarding the processes of central fill facilities. Now, I cannot speak for all of the companies that utilize central fills, but at ours, we use live, honest to goodness technicians to fill the prescriptions, with pharmacists verifying every prescription sent out. Granted, approximately 30 percent of the 10,000-15,000 prescriptions filled on a daily basis are filled with an automated system that is over seen by a tech, but the remainder are filled by trained technicians using counters and scales. What makes it efficient is that a production line like design is used to expedite the process.
Because of the various double checks in place, our accuracy exceeds that of our sister stores, and the in store pharmacists are able to spend more time consulting. The bottom line is that we are providing better service to our customers than before. So it is not a matter of re-evaluating the role and process of the pharmacists, but rather adapting to a more efficient system.