Pharmacist news letter Pharmacy automation

Pharmacy automation pitfalls

Pharmacy automation is not a silver bullet

Pharmacy automation is the future! You’ve heard this before, but only rarely is pharmacy automation evaluated objectively and, spoiler alert, it’s not all sunshine and rainbows. The reality is operational and clinical pharmacists are becoming increasingly dependent on automation and IT solutions to solve their problems; this phenomenon is what I like to refer to as “IT creep.”

I’m going to go ahead and gloss over the pros of pharmacy automation because I think they’re largely obvious and intuitive to practicing pharmacists. There’s no real reason for me to rattle off how computers and pharmacy automation can save time and increase productivity. You’re probably more interested in the pitfalls, the “gotchas,” and the things you didn’t know you should consider before committing to an IT or automated pharmacy solution.

IT hot potato and IT creep

As clinical and operational staff become more aware of IT solutions and resources they begin to use IT to solve their problems more frequently over time. That is, all solutions eventually become IT solutions even if they don’t need to be. I like to call this phenomenon “IT hot potato” or “IT creep” depending on the intent (and my mood). This is where operational problems that don’t need an IT solution are contorted in such a way that only IT-centric solutions are even considered. This is predictable behavior because submitting a request to IT means you don’t have to do much, if any, work yourself. There is zero incentive to even consider non-IT solutions to problems and, I would argue, there is a strong disincentive. Why wouldn’t you use a resource that’s available to you? Why wouldn’t you delegate? We’re all very busy after all and it makes sense from the perspective of the individual making the request. Once this behavior progresses past a certain point the problem every institution eventually has is a strong bias towards IT-centric solutions to all problems, prioritization issues, and overwhelming their IT department with requests. IT is seen as a pure cost to institutions and teams rarely grow in size even though their responsibilities continue to grow month by month and year by year.

The technical debt

Technical debt is the elephant in the room. It’s the 900-pound gorilla. It’s a ticking time bomb and you probably don’t even know what it is. So what exactly is technical debt? Technical debt, as it relates to pharmacy automation, is the long and short-term maintenance and documentation burden created when any new automated IT solution or enhancement is implemented. All IT solutions have some amount of long and short-term maintenance associated with them which is, unfortunately, almost never budgeted for or considered.

Here’s an example:

You decide to implement a new automated safety solution in your EHR. High five! Things are looking great and the solution performs well. Over the years, however, a few things have happened. Your staff has had some turnover and many other enhancements and changes have also been made to the EHR. You start hearing reports from staff that your enhancement doesn’t seem to be working consistently anymore.

It turns out the newer IT staff members were not aware they were supposed to incorporate the enhancement into their workflow because it was never written down anywhere or explained to them. The original staff just remembered because they were the ones that created the solution. That is, there is no system in place to automatically remind new staff to perform these tasks.

The newer staff are also having difficulty figuring out why the enhancement isn’t working consistently because the code wasn’t documented (it doesn’t have comments explaining how it works and why certain decisions were made). The remaining original staff are also left scratching their head too because it’s been years since anyone looked at the solution in detail. 

Once the IT staff really digs into the issue they find out the enhancement hasn’t been working properly for quite some time. Nobody knew because no one was proactively reviewing and auditing the enhancement and looking for issues. Until now they’ve been entirely reactive. If no one puts in a ticket requesting a change nothing is done and the solution is ignored. You find yourself in a situation where an unknown number of potential safety fallouts have occured.

What this example demonstrates practically is that the workload on IT will continue to increase over time as more and more automated solutions are implemented. When demands increase (and they always increase) what corners do you think will get cut first? That’s right, long and short-term maintenance and preventive tasks that no one is asking about or looking for. The team shifts further to a reactive model.

Make no mistake. IT solutions like everything else in this world are subject to entropy. Over time they will fall apart. Preventive maintenance, auditing, and quality documentation is how this is circumvented. If you’re not doing it, or not doing it well, you’re putting yourself in a vulnerable position. This translates to patient safety fall-outs and big fines from governing bodies.

The tools in your toolbox

If you’re not building your own in-house IT solutions you’re buying those solutions from somebody else and I can guarantee you they aren’t cheap. This is healthcare afterall. Relying on outside companies to fulfill essential job functions also increases your vulnerability. You have a weaker negotiating position when your contract needs to be renewed because you need them and switching vendors is painful and expensive. You may be subjected to increased costs over time or simply suffer in terms of productivity if that tool or solution ever breaks. How many times has your project or solution been held up for long periods of time because you’re waiting on a vendor to perform a task? I rest my case.

My advice is to make a true effort to understand what your in-house resources are capable of. You’d be surprised what they can create and you probably aren’t utilizing them to their full capacity if you don’t work in IT yourself. Afterall, you don’t know what you don’t know. It’s very important that you take the time to learn what services are offered by all of the IT departments connected to your institution. You need to know what tools you have in your toolbox. If you don’t, you may end up stuck with an unnecessary expense or contract. That or a really complex and expensive solution to a simple problem.

It’s also important not to over-utilize your IT staff with special and unique talents. This might be an analyst with a penchant for website development or computer programming. That is, they weren’t hired for these functions specifically but they became proficient through whatever means. If this staff member were to ever leave their replacement is very unlikely to possess these same special skills because they’re not required of the position. This means the new person won’t be able to support and maintain all of the fancy solutions created by the old staff member (the one with the special talents) which, again, puts you in a vulnerable position. Remember the IT entropy I mentioned above? Everything breaks eventually. Over time other departments may begin to expect these services and become dependent on them; they won’t be happy if the service or support is taken away. If you stick to services outlined in job descriptions this won’t ever happen to you.

Conclusion

We’ve talked about several pitfalls related to pharmacy automation and IT solutions so I will summarize the key takeaways. First, always have a measurable metric to track before and after a solution is implemented. Don’t implement things just because they sound like a good idea. How are results going to be measured and tracked over time? If they can’t be measured or tracked how do you know you spent your time and resources wisely? Second, budget for technical debt; set aside time to create quality documentation and audits. You need to be proactive, not reactive if you want to thrive in the long run. Third, know what tools you have available to you in-house by taking the time to learn about all of the services your IT departments provide, not just Pharmacy IT. Finally, learn to prioritize fewer, more important items and consider non-IT solutions to your operational problems. The old saying goes: if everything is important then nothing is important. It’s also critical you realize productivity decreases as the number of solutions that need to be maintained continue to increase over time (they’re rarely ever retired) and, remember, IT is a fixed resource.

William M Coyne, PharmD, MBA

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