I'm just waiting for these massive corporations to get into the automation of Pharmacy work. I know a number of highly paid (110k+) pharmacists who largely:
A) count pills
B) put pills into orders
C) do retail
D) answer questions/customer service
Meanwhile, the industry is being flooded with new graduates from dozens of schools...If this isn't a case for automation of A-C, I don't know what IS a case for automation in healthcare.
You've got it backwards. Pharmacists are hired because it's legally required. They're there to catch the dosage mistakes, look out for potential interactions, and to answer questions about medication and the proper usage. You cannot legally distribute prescription medication without a pharmacist physically present.
CVS and Walgreens would love to get rid of the pharmacists -- they hate that each store needs a couple $110k/year pharmacists just to handle the legal requirements and to be on-site for the few cases where something needs extra attention. That's why they put them to work doing the manual retail side of it to get the most for their dollar.
It's legally required because even with a prescription, an untrained person can't just walk to a hypothetical drug store with everything on the shelf and safely select what's written down. There are too many chances to make mistakes, misreading the label, self diagnoses and prescription of dangerous substances, etc. This can be addressed by automated, human-free system with tech we have today. Your doc sends a valid Rx, a box dispenses your drug. I don't know if it would be cost effective today, but we could do it and it stands to reason that one day it will be cheaper than doing it (validating substances and dose) with one highly trained human counting pills by hand at every single location.
Potentially dangerous drug interactions and instructions can be solved by automation for what can be automated and tele-pharmacists in all others.
This can be addressed by automated, human-free system with tech we have today. Your doc sends a valid Rx, a box dispenses your drug.
Sure, what would be necessary is a GUI that was as usable and flexible as the doctor's hand-written scribble while being standard enough across the country that any doctor could use and every single drug could be dispensed by it.
Which is to say that this is a really massive undertaking and opposition from a multitude of angles, including opposition from companies that have invested in most half-assed solution. Which is to say, this likely won't happen or it will require more than one more corporation dipping their toe in this.
A very large part of what pharmacists do is double-check the doctor's work. Mistakes, miscommunication, overlooked drug interactions, etc. In a sense the purpose of a pharmacist is having an accredited person dispense the medication as part of the pharmacy's liability insurance.
Because it's not the case that the pharmacist is automatable. A small fraction of the work is completely un-automatable and the easily automatable stuff is just busy work. Even if you automated it they'd still have to hire a pharmacist, he would just have less to do.
Drug interactions are not a lookup. Some people have problems some do not. We don't even have interaction data on all possible combinations of two different drugs, much less all the 6+ different drugs that some people are taking. There is a lot of "Educated guesswork".
For someone only taking one drug for a couple weeks and the a year latter a different drug for a few weeks it is easy.
Seems like there would be the possibility of WFH pharmacists whose job is to do the educated guesswork on any newly observed combo. Log it into the system after some validation and voila we have timeless knowledge for all who come later, automated at low costs.
I saw this (or one like this) in action in China at a hospital. There were 15+ windows to line up for the pharmacy and each one had a lot of 10+ people. I was in shock because in the US even 2 people in like would take forever.
The procedure is, you scan your ID at a machine attached to a pillar. The screen tells you which line to line up in. When you get to the front of the line you hand your card to the nurse the medicine comes down a chute.
The line moved fast. I received my medicine in a matter of minutes. Also I paid for the medicine w/ the doctor that prescribed it - so none of this BS about "oh your insurance doesn't cover this, you haven't met your copay" talk that half the pharmacists seems to spend their time with. The doctor told me what to do with it and fielded any questions.
Moving prescriptions or getting a new prescription especially for controlled substances or things that require prior authorization from insurance co is just a PITA from a user perspective.
Exactly, the pharmacist is there to provide expert advice when you have a complicated prescription or combination of prescriptions. You can tell by these comments that the HN crowd leans young -- not enough people dealing with chronic illnesses who have seen the value in having a consult with the pharmacist when you pick up your medication.
My wife has a handful of chronic illnesses and I want her to be able to ask questions of someone who has been educated in the role, method of action, correct dosages, and possible interactions of her medications.
In my experience, medication interactions are both solidly in the wheelhouse of physicians and taken quite seriously. As someone below pointed out, it's still a huge problem, and having more eyes and a distinct training/set of skills in the pipeline is a win for everyone.
I do not know this as a fact, but I don't believe US pharmacists are able to adjust dosing on the fly - though of course they can and do reach back out to physicians with questions.
I had an experience recently that really solidified my respect and appreciation for pharmacists though. I was standing in line behind a older gentleman who had maybe a 10 minute conversation with the pharmacist. I tried to mind my own business but couldn't help but hear the overall gist. He was very confused about what his medication was for and especially how to take it. The pharmacist clearly had a relationship with him and wrote down schedule based on the meds he was already taking. He thanked her by name and she told him she's give him a call later in the week to check in on how he was managing.
I was curious (and the last person in line) so I asked her about her work and how often she ends up so involved. Apparently she made lots of calls throughout the week to people, and people came in confused about their medications often enough. By percentage it sounded like a minority of the patients, but her assistance was obviously super important to a lot of people in the neighborhood.
I don't think I've ever asked a pharmacist for more info on my life, but I'm very grateful they exist as a resource. At the very least, I think it's important we don't think of pharmacies as counting factories that can be replaced by robots. And while I'm all for dropping the price of healthcare across the board, I hope the kind of value that kind of one-on-one interaction at least gets it's fair shake in any accounting done thinking about making a switch to tele-pharmacies and the like.
You realize there are reasons we have old people and computer tech support memes right? Replacing humans in the loop would do absolutely nothing to help.
From what I've been told, physicians spend a relatively short amount of time actually studying the details of drugs while pharmacists spend several years and know considerably more about dosing, interactions, etc.
Doctors do not do a great job of balancing the behaviors of and interactions between prescriptions. You could say that they should do a better job--probably justifiably--but pharmacists do that for a living.
My doc, who's a great diagnostic, has a fantastic network and usually knows his shit prescribed a pain killer (Vimovo, which in addition to the pain killing compound contains a proton-pump inhibitor. The compound which reduces acid production in the stomach, so that the pain killer is much more gentle to it).
He advised to take it after food, which is true for any old pain killer (for example Ibuprofen), but not for such specific medications.
In fact it should be taken half an hour before a meal.
That's the reason why it's prescription only and deployed by a pharmacist, who immideately caught it an gave me correct advice.
Physicians (and other prescribers such as dentists) don't even necessarily know what all medications a patient is taking. In theory they can check through the regional Health Information Exchange or Surescripts but in practice things fall through the cracks. This is a leading cause of preventable medical errors.
The unfortunate part of modern American medicine is that the pharmacy isn't likely to know all the medications the patient is on either. I'm currently going through a minor situation but have discovered that health insurance has, in some cases, switched to a model of partnering with specialized pharmacies for certain treatments. You're forced to use a specialized pharmacy for one specific condition while your day to day corner chain is completely excluded.
You can even get that without having some prescription that your insurance has made a special deal with. I currently have 3 prescriptions at Walmart and 1 at Safeway, all of them generics that I'm not using insurance for. I'm paying the cash price for the Walmart ones, and using GoodRx for the Safeway one.
It used to be all 4 at Walmart, and then something utterly ridiculous happened. For the non-US readers who won't believe this idiocy, I swear it is true. We really do put up with this nonsense.
One of them was for irbesartan. I'm supposed to take it twice a day, 150 mg each time. The prescription was written for 30 x 300 mg tablets, which I split in two (irbesartan comes in a rod shaped tablet that you can easily split it two by hand).
This is $9 cash at Walmart.
But then there were some irbesartan recalls (although not affecting the manufacturer of any tablets I had). There was a shortage of 300 mg tablets, and Walmart was having trouble refilling my prescription.
So we had my doctor change it to from 30 x 300 mg tablets to 60 x 150 mg tablets. The cash price for 30 x 150 mg is $9 at Walmart, same as 30 x 300 mg. (I'd guess that for this drug, most of the cost is in filler and binder, so that is probably not unreasonable). So I'd expect 60 x 150 mg to be $18.
Walmart filled that, and when I went to pick it up...it was something like $300. WTF!? So they double checked, and found out that it had actually been written as 180 x 150 mg. They redid it as 60 x 150 mg, which dropped the price to about $100. So, still a big WTF.
According to GoodRx it should be $24 cash (still a WTF...why not $18?). Since this is one that GoodRx thinks has a good cash price at Walmart, GoodRx does not offer a coupon for it there. I showed the pharmacist the listing in the GoodRx app, and he agreed to honor that price, so I got my prescription for $24.
GoodRx did have a coupon for Safeway, for 60 x 150 mg for around $13, so when it was time to re-fill that, I move it there. (That changed to about $18 next month).
I ran out of re-fills about 3 months later and so needed a new prescription, and by then 300 mg was readily available again so asked for 90 x 300 mg, which was $21 with a GoodRx coupon at Safeway.
I mean this may be partially true for a retail pharmacy setting, but is much different in a clinical one.
Even in an place like Walgreens where customer service is a big part of the job, the idea that it's all a pharmacist does feels simplistic and reductionist and plainly wrong. There's lots of coordination with the patient's doctor and insurance and other pharmacies they might use.
It's like saying programmers just type into a keyboard.
That's one thing I've wondered about as well. Most of what pharmacists do can be automated and should be automated. That doesn't mean pharmacists should be without work. Their expertise should be applied elsewhere. What's the point of getting so much education to simply count pills?
Better yet, why can't your doctor just send the request to a pharmacist facility and have them fill the order and deliver it to your home? Why does he hand you a piece of paper that you have to bring to a pharmacist? When you give blood, you don't take the vials/tubes to the testing facility. The doctor's office sends it where it needs to go.
Most of A, B, and C are done by techs. Pharmacists are there to manage the techs. But predominantly they are there to be prevent or be held liable for mistakes and loses/thefts of very high value inventory.
The automation of pharmacy needs to happen in two areas:
1. Count pills and package them.
2. Drug interaction detection.
1 can be automated. In fact the warehouse style pharmacy can do all that. The doctors (or you) send the prescription to the pharmacy warehouse. They ship the medicine to you.
2 can also be automated. Drug interaction are sets of rules and the detection can very well be done with machines.
Pharmacists are Health Care professionals and they're part of the chain of credibility. You absolutely want credible people dosing out medicine, double-checking, etc..
In no uncertain terms should unqualified people be answering questions about anything healthcare-related.
Just the smallest questions I ask my pharmacist, I can tell she is super well trained: relatively clear when she can be, when she doesn't know she indicates this, for things out of her bounds she refers to the doctor. Very careful communication.
For a little over $100K + all the training, I'd say it's a reasonable deal. That's about the professionalism you'd want before having someone chime in on your health.
Maybe it could be reformed but I think pharmacists are valuable.
Pharmacy revenues will remain constant. The only difference is that instead of paying pharmacists, all that money is just going to sit in the caymans, with all the other automation gains.
Should we bring back telephone operators too? The price for phone service (especially long distance) has dropped since phones were invented, surely some of that is due to automation and tech advances.
Do you think technical progress is making life worse for the average person? I realize it's popular opinion (and I tend to agree) that it's disproportionately benefiting the richest. But that doesn't mean most people aren't benefiting from the cost/time savings that new technology has brought. Curious to hear why you think that way.
I have serious doubts that tech is making us happier, overall, and that is’s actually significantly improving productivity, outside a few areas where is has done so massively such that the effect is still strongly positive.
Exceptions for certain areas like medical research, obviously, but really, things were fine before Netflix and free long distance and such.
I'm just talking about pharmacists and telephone operators. I dont mind pharmacists and I didnt mind telephone operators. My life isnt much better now that telephone operators are gone.
It is absolutely not a do nothing job. Every one I've ever interacted with seemed overstressed from the insane work load/hours, if anything. 12-14 hour shifts are common.
It's an okay gig on average, currently. Chains keep buying the smaller guys out, reducing hours and support staff, increasing demands of metrics, and offering lower and lower pay to new grads. It doesn't help that new schools keep opening and applicant numbers do not increase in quality or quantity. The BLS anticipates 0% job growth in the next 10 years.
A) count pills
B) put pills into orders
C) do retail
D) answer questions/customer service
Meanwhile, the industry is being flooded with new graduates from dozens of schools...If this isn't a case for automation of A-C, I don't know what IS a case for automation in healthcare.