Community hospitals are the new target for a pharmacy automation system that started as a business school project and has evolved into one of McKesson Corp.'s fastest-growing units.
The idea is simple and proven in industries outside healthcare: Use robots to perform the boring, repetitive tasks that humans hate and often screw up. If Ford and General Motors can replace welders -- lowering costs and improving quality in the process -- why can't hospitals relieve pharmacists and their technicians from the drudgery and possible errors in counting pills?
Among the host of automated solutions being offered to answer the question, none goes quite as far as San Francisco-based McKesson's Robot-Rx. Now operating or being installed at 93 hospitals, the robot technology first made waves at tertiary-care centers, which some wags might say already bear more than a passing resemblance to factories.
Installed in hospitals large or small, McKesson's whirring, tireless robot stocks and tracks centralized inventory and assembles individual patient orders on demand. The robot never wastes time on coffee breaks nor does it need caffeine to stay alert. As a result, McKesson says the robot has been error-free in dispensing nearly 50 million drug doses.
Now scaled-down versions of the McKesson robot are starting to catch on at community hospitals with only a few hundred beds.
That's a far cry from the mammoth factory floors where inventor Sean McDonald, president of McKesson Automated Healthcare, got his start substituting machines for men.
"I worked in Detroit putting windshields in Escorts," he explains. But during business school, McDonald, an engineer, searched for rote, repetitive tasks in other industries that like automotive manufacturing require a high degree of accuracy. In healthcare, pharmacy operations fit the bill.
Almost two years ago, McKesson bought the company McDonald started in 1987 to commercialize his idea. Now McKesson is pushing the robotic vision to hospitals on Main Street.
One community hospital showsite is 263-bed St. Mary Medical Center in Langhorne, Pa., about half an hour from Philadelphia.
Executives at St. Mary wanted to improve quality of care by getting pharmacists out of the back rooms of the central pharmacy and onto the patient floors. Since starting with the robot in January 1997, the hospital has eliminated the need for three technicians, who were phased out through attrition. In addition, six staff pharmacists began to spend four hours a day on clinical rounds instead of supervising pill counts.
Though conceptually beguiling, many hospital executives would blanch at the prospect of shelling out $700,000 to $2 million to buy the robot and then forking over $5,000 to $10,000 a month in ongoing service and licensing fees.
But McKesson asserts, and several users confirm, that the robot can quickly earn its keep.
"I felt the capital commitment would be neutral . . . and as we go into the future it will more than pay for itself," says Sister Clare Carty, president and chief executive officer at St. Mary.
Right out of the box, the robot reduced medication mix-ups.
"People aren't bad people; they're in a process that's failing them," says Kevin Seip, director of pharmacy and materials management at St. Mary. Seip considered other automated solutions, such as floor cabinets, but recommended a robot to senior management because, among other factors, it would cut rather than increase inventory.
As expected, quality of life for the staff and patients has improved.
"I'd much rather be doing clinical work than counting," says Suzette Cunicelli, a pharmacist at St. Mary. Early on, pharmacists like Cunicelli were able to start customizing doses for difficult medicines and to assist doctors in switching patients to pills from intravenous drugs. Both efforts improved patient comfort and reduced lengths of stay.
Despite the success stories, robots aren't a panacea. They can't handle all drugs because of size or weight restrictions, and many state laws require a pharmacist to be personally involved in the filling of controlled substances. Furthermore, to wring out costs and improve quality, management -- not the robot -- must follow through on changing the way departments are staffed and run.
In a first cut, hospitals have to look hard at their pharmacy volume and potential labor savings to justify the purchase. Even the scaled-down robot may be more than many institutions really need. But for those who want their pharmacists on the front lines of patient care, a robot might offer a fast track to the future.
"We want to get out of the business of moving drugs around the building," says Michael Dupuis, directory of pharmacy services at Optima Health in Manchester, N.H., another McKesson robot customer. "That's not really the value of pharmacy."