Walgreens Turns to Prescription-Filling Robots to Free Up Pharmacists
wsj.com
wsj.com
Pharmacy techs are the ones that fill the scripts, but the pharmacist is ultimately responsible that it's correct.
Pill filling robots are great if you're filling the same 10 scripts, but not very useful when dealing with complex and compounding scripts.
My father was a pharmacist and we owned an independent pharmacy and I remember how often the scripts written by the doctor was so wrong and had it not been caught it would have killed the patient.
Knowledge of drug interactions are key, but these days new pharmacists just look up online, so a pill filling robot could work.
Like, isn't the human just going to have human error (like the doctor)?
Humans tell a calculator how to calculate.
It's never wrong. Humans (without a calculator) get math wrong constantly.
Humans aren’t perfect, but computer programs are only as good as the programming.
it's like saying autonomous driving is easy you just have to follow the road and read the signs, we have the best minds and unlimited money working on it for a decade+ and it still suck ass
Whereas the software will gladly just make the same mistake over and over again until corrected.
The dictation on my phone is pretty good. It's still frequently wrong.
The problem is that patient charts are often incomplete, or lacking proper RxNorm or NDC codes for the current medication list. So competent clinicians have to prevent problems from slipping through the cracks using their judgment and intuition. This is not something which can ever be automated (short of a true AGI).
The first seems like a problem - but not something a top 5% wage earner needs to do. The second can be handled by machines just fine.
Addressing gaps and errors in a patient chart is a highly complex task. Low skilled workers don't even know what to look for, or what questions to ask. A lot of this is tacit knowledge which we don't know how to reduce to software.
Than it should warn the human doctor before he write the script.
https://www.healthit.gov/test-method/drug-drug-drug-allergy-...
The problem is that the patient's chart may be erroneous or incomplete. So the system can only detect harmful interactions on entries that are fully populated with RxNorm (or NDC) concept codes. Human doctors are expected to manually reconcile the medication list before writing a new prescription. But sometimes they skip that step, or patients don't even remember what other drugs they're taking. In some cases it's possible to query the patient's current medication list from a service like Surescripts but even that won't necessarily be complete and some level of manual reconciliation is still needed.
The other issue with drug interaction warnings is alert fatigue. For certain drugs there are a lot of known interactions, but those are considered minor acceptable risks due to lack of a better alternative. So clinicians get into a habit of ignoring all warnings and miss the ones that are actually serious. From a UX perspective there's no good way to solve this problem in a way that satisfies both the clinicians and the lawyers.
One of my bosses has a photo of her and a child's prescription fixed to the wall of a paediatric consultant who would have a killed a child if a pharmacist, my boss, had not queried a prescription.
Checking each other's work is essential in many industries but more so in healthcare.
1 human error in the software = millions of people affected
1 human error by a pharmacist = 1 person impacted
Beside overflows, it doesn't error.
And yet, who's writing chess software?
And yet - there's no human in the world that can ever beat a chess program.
And yet, who's writing Google?
And yet - there's no human in the world that can recommend webpages like Google.
The list goes on.
Humans are bad at memorizing a GIGANTIC lists and not making mistakes.
Humans are EXCELLENT where error is okay and it's not really clear what the goals are.
I don't really know anything about pharmacy - but it does not appear to fall into category 2.
Push calculators far enough and they'll all give you different results
We're talking potential human life here.
If you don't see the difference between a dumb game like chess and the infinitely complex world of medication and facing patients I honestly don't know what to tell you. Every customer facing people we replaced by computers degraded the experience for the customers
Right now large chain pharmacists basically have to talk and fill at the same time to keep up. That’s not good for patients either.
Not only do blister packs save so much waiting time — you never have to wait for it unless it's out of stock — but it also feels like there's less chance for anything to go wrong when manually handled by the pharmacist, factoring cross-contamination or incorrect filling, even though the pharmacists would either way be liable for it.
Blister packs are verifiably sealed by the manufacturer, you're more likely to tell if they've been tampered with, you don't have to worry about moisture seeping into the excipient and interacting with the active ingredients, and they provide a visual representation of how many pills you have already taken, without needing to count pills in a bottle.
But if you think of drugs that are dispenses in the tens of thousands each month, like cholesterol medication - the amount of packaging the pharmacy would have to store would be massive.
Giving consumers individual packages with counterfeit-deterrent measures and serialization that can be verified with the manufacturer as part of a valid production lot increases consumer confidence and makes counterfeiting more difficult.
To the people saying pharmacists should not be involved at all, that is insane. Prescription errors are a very large source of preventable error that causes significant harm. Lots of error cannot be solved by computer because it lacks the information, like identity, drug and dosing errors. There are a lot of inputs that only a human can evaluate at dispensing time. This robotic filling, as I read it, does not necessarily prevent that.
For reference, there are roughly ~110 million possible drug formulations (drug x dose x route etc) that are currently legally dispensable and distinct, in the US. Any drug can interact with any other, different dose x route x drug combinations may interact differently. A large set of the population is on dozens of drugs simultaneously. Taking into account the patients age/weight/race/level of sickness is important and makes the overall matrix very very large for raw computation.
You might then say: well humans aren't good at a matrix that large either, that is in some ways true but humans are pretty good at detecting exceptional circumstances even though though they are not rotely walking that large key space. It is also true that there is a heavy weighting towards about 1,000 much more common drugs. It is not a new idea to add computers to interactions/dispensing/etc. It has been tried for 20 years, the outcome results of many efforts have been poor.
A gold standard in pharmacy interactions is to maximize the amount of time between pharmacist and patient. Pharmacists aren't pill monkeys rotely stuffing things in bottles. They have important diagnostic, education and safety functions. Especially when they can see and interact with the patient. If there was any true broad economic incentive to be preventative pharmacists would take your vitals and temperature as well but currently our system does not make that economic.
There’s also nothing that says that information couldn’t be transferred along with a prescription. It’s not like a centralized system wouldn’t have all that information about you, along with any other prescriptions and even non-prescription medications previously purchased with Walgreen’s (or any other pharmacy, they all do it) rewards card.
A computer can also certainly be trained to identify outliers, and can certainly process complex interactions (not that there’s nearly as many or as varied and diverse as you’re making it seem) better than a human can, with the same data. At the end of the day there’s a finite number of these interactions, and while things like dosage might affect some, overall it’s groups of drugs that interact with each other which is generally looked at.
Finally, at least for me, every time I get a prescription filled I get literally a 5 second conversation with a pharmacist at best. 10 seconds if it’s a new prescription with a particularly bad side effect.
Suffice to say, I don’t think you’ve shown why exactly a human would be better than a machine at this job.
I wish I knew too, because one of my scripts is like that as well and it’s only a 30 unit script.
Pharmaceutical packaging is highly regulated but with some variation in the details, depending on the country of origin or the region.
For other drugs, in practice you get short supply on a drug, and can only fill a partial, or you have patients that only want a weeks worth.
Another factor is the packaging adds extra cost, and it's cheaper to order a bulk 500 count bottle.
It’s mostly only the USA that has bulk packaging that is then counted out into bottles at the time of dispensing.
Something like 10-20 drugs make up like 80% of the maintenance meds dispensed in the US daily.
Supply chain efficiencies like this were monetized 20+ years ago by most of the major PBMs/health plans (look at their 'mail order dispensing pharmacies' to see them in action).
Doing a regionalized fulfillment play for your high volume geographies will likely save hundreds of millions in opex i'm guessing.
Will be curious to see if WBA can scale as quickly as they want here. I'm sure there are many industry partners who could lend a hand :)
Like kiosks at fast-food places?
Personally I'm sticking to mail-order rx for the rest of my life, pretty sure I caught covid at the pharmacy from the pharmacist who was refusing to mask. Imagine how filthy that checkout pad is at the pharmacy with every sick person touching it. Plus the prices are much more competitive.
And we know that automation greatly reduces costs.
The automation isn't the problem, it's capitalism. The gains from automation are realized by the owner which isn't the worker.
People don’t get fired. Worst case is the company stops hiring, and lets “natural attrition” take over.
Companies spend a lot of money hiring people, and good workers are hard to find.
If you’re happy with an employee, and they would prefer to stay instead of find a new job, then you have a good match. Don’t mess with that.
But the thing is people think going to college and studying a lot with a big time investment to become a pharmacist is probably a long-term job.
Now a pharmacist is basically a minimum-wage job, they are replaceable on demand by season and profitability.
This doesn't bode well for a society when you rely on someone who then believes their job is disposable.
Then there is that pesky anchor in the USA of health insurance tied to a job.
I really like how the pharmacist who knows literally nothing about me, my diagnosis, life circumstances, family history etc... is supposed to be "the last line of defense" against all those silly doctors writing prescriptions that will kill their patients. It almost seems like the doctor might be the right person to decide what medications would work for me.
If I didn't know better I might think that pharmacists inflate their importance to try and maintain their comfortable position with a nice salary for a job that a fancy soda machine could do.
See /r/pharmacy or sdnforum.
Maybe not for filling your 1 script - but for polypharmacy patients it saves lives.
Why does this difference exist?
Humans can ask questions or have information about the patient that the very rudimentary algorithms don’t.
It's so much worse than that. The standard for side effects is pretty low and relies mostly on patient reports. So there ends up being a long tail of extremely rare or misattributed side effects.
It’s generally not “drug A and drug B combined with definitely kill you” it more of “there’s a small study that shows that people who take drug A while taking drug B have a higher chance of experiencing side effect C”, or “patients taking drug A who have condition D, might experience problem E”.
It’s about managing risk, making judgement calls, and accepting responsibility.
There also just isn’t data for every possible drug combination or patient problem combination out there.
I think most pharmacists would welcome the chance to count fewer pills and apply their PharmD skills.
Surely an algorithm would have flagged this as suspicious (I’d been on the same dose for years).
It's going to be fun to be on the front line when this new chain borks up and some bignum% of your customers can't pick up their Rx for a few days.
Or maybe you have no clue about robotics, and don't understand the actual complexities involved.
In all but the highest volume setting, this is a waste of money. That doesn't describe your neighborhood Walgreens. I'm confident that if you follow the money on this project, a board member of Walgreens owns part of the robotics company or is affiliated with a VC firm that's backing it. There's no way this isn't straight corporate legalized theft.
Feel free to follow up with me in 5 years when everyone's totally forgot about this farce.