Reprinted from ComputerTalk for the Pharmacist • September/October 2003

ScriptPro: Making Robotics Pay Off

Mike Coughlin, president and CEO of ScriptPro, located in Mission, Kan., talks to ComputerTalk Publisher Bill Lockwood in this exclusive interview about the many benefits of using robotic dispensing systems and how the company is now integrating new functionality and applications to become a total-solutions company for the pharmacy market.

CT: ScriptPro is viewed by many as a leader when it comes to the application of robotics to the pharmacy market. A good starting point might be to turn the clock back. How and when did you come up with the idea of developing a robotic dispensing system, and what made you think it would work?

Coughlin: The idea for using robotics in prescription dispensing originated in a research project at Kansas State University in the early '90s. ScriptPro became involved in 1994, and we presented it to pharmacy industry focus groups. They confirmed the need and gave us some pretty specific advice as to how it should work and how it should be controlled. We followed that advice and it turned out to be right on target.

CT: Tell us about the first installation. Where did this take place and how did it go?

Coughlin: Bill, ScriptPro's first installation was in March 1997, in the outpatient pharmacy at the University of Kansas Medical Center in Kansas City. We had an independent evaluation group follow the entire field test process. Their report was encouraging. The system worked well, and everyone involved liked it. Pharmacists and pharmacy staff thought it was great, and the patients liked it, too. They saw that the robot was making a real contribution to safety and accuracy. It was helping the staff keep up with the workload and allowing the pharmacists to focus more on their patients. A few days into the field test, several members of the pharmacy staff cheerfully waved to the manager and said “Guess what? We're going to lunch today!” The manager told us that they were rarely caught up enough to get in a lunch break. So the robot was a morale booster, too.

CT: What have you learned since that first installation?

Coughlin: There have been no fundamental changes — the robots we installed in 1997 are still in service and have been upgraded to the level of the products we build today. But, yes, a lot has been learned along the way. For one thing, we learned just how much support is required. As you know, the robot works in a very dynamic environment. There can be changes in personnel using the system, changes in drugs dispensed, changes to the other computer systems with which the robot interfaces. To provide the needed support, we moved quickly to build an infrastructure that maintains communications with the robots, assuring that they are always up and running and automatically updated with the latest software and drug information. We developed tools to implement computer interface changes.

Our customers found that the data collected by the robot can greatly increase visibility into pharmacy operations. The robot logs detailed, time-sensitive events such as script arrivals, customer wait times, employee utilization, and inventory levels. We are constantly working with our users, finding new ways to report and analyze this data to improve pharmacy operations. This is a huge value to our customers that we had not foreseen in 1997. Also, we have used simulation-modeling tools to predict and validate the effects of robotics on pharmacy customer service levels and operating costs. This helps us make recommendations regarding where and how to implement robotic dispensing. So there really has been a lot to learn above and beyond just getting those first robots into a pharmacy.

CT: Are there settings where counting systems make more sense than robotic systems, or are robotic systems really where pharmacists should be looking?

Coughlin: As you know, Bill, a robot performs a complete task. It prepares and delivers the finished product. A counting system, on the other hand, requires a person to hold the vial, affix the label, etc. The most expensive part of the counting system is the person. Counting systems have been around a long time, and they will always have their place in low-volume situations. This has been studied a lot, and I think it is now clear that once a pharmacy moves beyond needing a couple of people, say beyond 150 scripts per day, a robot becomes cost effective. A fully supported robot costs approximately $12 an hour and can do the work of several people. It can immediately respond to demand fluctuations. A robot is the lowest-cost solution for a pharmacy that wants to maintain target customer service levels.

CT: What are a few of the engineering challenges when applying robotics to the pharmacy market?

Coughlin: I would go back to our focus groups. They made it clear that the system must be absolutely free of drug cross-contamination. When you dispense pills through a common pathway, such as a chute or counting head, you have the potential for cross-contamination. The only way to be totally free from cross-contamination is to dispense directly from the drug cell into the vial. There was another fundamental requirement — drugs change frequently, so the drug cells must be able to handle all sizes and shapes without factory calibration. We addressed these challenges by developing a robotic arm that carries a vial to a plastic drug cell that can be easily adjusted to handle any tablet or capsule. The robotic arm engages the cell with a gear and uses software-controlled motors to cause the cell to dispense directly into the vial. It uses specially designed sensors to count the pills as they are dispensed. It took a lot of development work to accomplish this with the required speed, accuracy, and reliability.

CT: Would you agree that these systems are not the end point in themselves to improving workflow, but are part of the larger picture?

Coughlin: Well, in one sense the robot is an end point. It basically takes over half of the filling process. It automatically hands the pharmacy staff what they need to dispense for over half of the prescriptions. This frees up the staff from a huge amount of manual work so they can focus on their customers. In another sense, the robot becomes a driver in the overall pharmacy workflow system. It automatically does its job as prescriptions are entered into the regular pharmacy computer. In a sense, it's pushing the staff to get the scripts out. The work driver effect can be readily seen. Before the robot was there, scripts entered into the computer would build up in a queue, waiting for staff to fill them. With the robot in the mix, half of these scripts are filled immediately and the work is pushed through much more quickly.

CT: While we're on the subject of a workflow system: This is a loosely used term these days. How would you describe a workflow system, and what do you feel pharmacists are really looking for here?

Coughlin: I agree, Bill, this term is used a lot, and I'm not sure that it means the same thing to everyone. To me, the workflow system is the collection of productive resources and driving mechanisms that get the dispensing work done, hopefully according to an overall workflow plan. As I suggested above, the robot can be viewed as both a productive resource and a driving mechanism. Other productive resources would be staff, bar-code scanners, graphic verification screens, label printers, etc. Another driving mechanism would be something like a computer screen that prioritizes the work, collates prescriptions for a patient, or follows up on partial fills, etc. Basically, pharmacists want and need a fully integrated workflow system with all of the required resources and drivers in place and working in unison. The system should receive the patient, receive the patient's prescriptions, fill the prescriptions, pull the complete package together, hand it off to the patient, and provide counseling and quality interaction with the patient. The objective is to have the patient leave the pharmacy with the right products and the right information, and with a good feeling about the services received.

CT: At this year's NACDS Pharmacy & Technology Conference in Philadelphia, you were showing a line of new products, all fully integrated with the ScriptPro robotic units. These included products that address will-call and delivery management, e-signature capture, telepharmacy, and even a host system. ScriptPro is no longer a single-solution company. Is this in response to market demand?

Coughlin: That's right, Bill. We offer a complete system built to a comprehensive and flexible workflow plan. Our customers have asked for it, and we now provide it. We have synthesized this from our experience installing systems in thousands of pharmacies.

CT: You mentioned simulation modeling earlier. Would you elaborate on this?

Coughlin: Every pharmacy has certain demand characteristics, such as customer arrival patterns, number of scripts per patient, new versus refill scripts, etc. Given a defined workflow system, i.e., staffing levels, methods for prioritizing the work, robotic support, etc., it is possible to predict the outcome. For example, a simulation model can predict customer wait times. It can even predict how many customers you will lose when wait times get too high, and what the cost of this might be. Basically, a simulation model can lead you to the lowest-cost solution that maintains the level of customer service you desire. Simulation modeling really demonstrates the value of robotics in the pharmacy. Demand rates are uncertain, and it is very costly to throw more people at the problem. The robot is equivalent in cost to approximately one technician, and provides capacity that is always there, ready to help maintain customer service when there is a spike in demand.

CT: So robotics can make sense even for a pharmacy filling 150 prescriptions a day?

Coughlin: Yes. When a pharmacy gets to that point, it is probably going to be adding capacity. The robot may be the best addition, particularly if continued growth is projected. With a robot, the pharmacy can add the capacity of several people available at all times, yet at the cost of only one person or even a fractional person. With the robot, you also get a work driver that pushes the work through. You can now handle higher volumes without adding staff and with better customer service than you had before.

CT: Aside from the operating efficiency and improved patient safety that robotic dispensing can offer, what other value do these systems bring to a pharmacy?

Coughlin: As I mentioned earlier, there is a lot of valuable operating information collected by these systems. Our chain customers really use the reports that compare store to store. They sometimes find that stores with higher costs and lower customer satisfaction levels are refilling the robot during peak times, whereas more-efficient stores are refilling the robot at night, when the store is not busy. We can give them all sorts of valuable information, such as how long vials wait on the conveyor before they are dispensed to the patient. This allows them to identify those stores and managers employing the best practices and to promote best practices throughout the chain.

CT: From what you have said so far, it appears that the company's support infrastructure would be of paramount importance to anyone considering a robotic system. What are your thoughts here?

Coughlin: Pharmacy robots have to be dependable. If not, they can be a liability instead of an asset. Our robots get an “EKG” test in the burn-in area before they leave the factory. The EKG is monitored in the field and the robot lets us know if it's having a problem. Incidentally, Bill, they are usually given names — the most common one being Lucy. The robots also call in and tell us if they are not being treated right — for example, if the counting sensor is not being wiped off once a day. Basically, they become part of the pharmacy staff. At one of our sites, the boss nominated the robot for an Employee Appreciation Day award. It won — and got Monday off! However, at the insistence of the staff, it was put back to work midday.

Our customers pay a monthly “health insurance” premium that covers everything, including on-site emergency service. So you see, it's not just the robot, it's the total support system that stands behind it. Over half of ScriptPro's 600 employees are focused on support.

CT: You are considered by many as a “thought leader” in the industry, and have been an active participant in a number of discussions dealing with the topic of pharmacy automation. Putting on your visionary cap for a moment, where do you see us going next with pharmacy automation?

Coughlin: It's important to have a long-term view here. The role of community pharmacy is expanding rapidly as the health care needs of society grow and as medical services continue to move toward outpatient treatment and drug therapy. However, there are those who believe this role should be taken over by mail-order prescriptions and telephone counseling. ScriptPro believes that community pharmacy's personal interaction with patients has irreplaceable value in the health care system. ScriptPro is dedicated to helping community pharmacies provide to each patient the correct and complete set of drugs and complementary products, along with the education, motivation, and interactive monitoring to assure maximum positive impact on the patient's health and quality of life. To accomplish this, we need a much more comprehensive systems model than we have had in the past. We are going beyond a collection of computer programs and devices toward a fully integrated system to run the pharmacy.

CT: It's impressive to hear what ScriptPro has been able to accomplish in six short years. Any closing comments?

Coughlin: Keep in mind, Bill, that we spent three years developing the first robot before we sent it out into the world. We've been at it almost ten years now.

For a closing comment, I'd like to say that community pharmacists have always been an inspiration to us. Their job is very complex and demanding. They are, first and foremost, dedicated to their patients, and they never lose sight of that fundamental responsibility. At ScriptPro, we have taken a great deal of satisfaction in seeing how our robots and other products have helped thousands of pharmacists work at a higher level and serve their patients better. CT