What portions of a pharmacist's job are impossible to automate?

[GeraldMonroe]

First, let me say that I have nothing against pharmacists. I respect the years of training you go through, and the fact that just getting admitted to pharmacy school is extremely difficult.

However, as I understand it, pharmacists in a retail pharmacy basically dispense the meds as prescribed by a physician, and deliver verbal counseling when necessary. Occasionally, they may be required to act as a safety check to prevent harmful drug interactions.

In return for doing this, they are compensated about $100k a year or more.

Now, I don't understand why an advanced vending machine could not do all of the above functions, with 1/10 the total number of pharmacists employed.

The vending machine would use a pill counting robot that would use machine vision to make sure the correct pills are going into the bottle. Drug manufacturers could put a number stamped into every pill made to make it easier for a robot to scan them. A digital scale would make sure that the pill bottle has the exact number of pills, and a careful audit log complete with a video taken from a camera inside the machine showing the pills going into the bottle would be kept.

Prescriptions would be completely electronic. Computer software would check for possible drug interactions and overdoses using a conservative algorithm, with an actual pharmacist overriding it when necessary. When possible, instead of an actual pharmacist giving a verbal lecture, a pre-recorded video of an attractive actor would give the instructions verbally for the particular medicine.

Whenever an actual pharmacist is needed, a licensed pharmacist in a call center somewhere would log in via telepresence and communicate with the patient, and/or override the pill counting robot.

Right now, a setup this sophisticated might be too expensive for today's technology. However, over the next 30 years, it seems obvious that it would become incredibly cheap to do everything I just described.

If 9/10 retail pharmacists were replaced in this way, what would happen to the rest? Are there enough positions in clinical pharmacy or future jobs a pharmacy degree would qualify one for?

Yes, every industry will change with new automation, but it seems possible to automate much more of a retail pharmacist's job than the jobs of the other health professionals on these forums.

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[ItsOverZyvox]

It would be hard to automate reading illegible prescription.

 

[fhx06]

It would be hard to automate reading illegible prescription.

I think he's referring to making prescriptions digital. One day... there will be a machine that will take body temperature, take fluid samples, analyze symptoms and lab results, and consider all possible ailments and provide a solution. Oh, and there will probably be a machine that can cut with precision into a person's body to remove all the nasties too. I guess by then we'll all be out of a job and we'll sit around a campfire discussing the good ol' days when we criticized each others' professions. : /

 

[MountainPharmD]

I suppose you could automate everything if you wanted. Why do we need primary care docs? Set up an automated qiosk that asks the patient a series of questions. Automatically orders labs and tests if needed. Then automatically send a prescription to the automatic pharmacy vending machine and no one ever has to see a real person.

Heck why do we need surgeons? They are already experimenting with robots doing surgery. Lets just automate everything.

Lets have robots take over the world!!!!!

 

[fhx06]

I suppose you could automate everything if you wanted. Why do we need primary care docs? Set up an automated qiosk that asks the patient a series of questions. Automatically orders labs and tests if needed. Then automatically send a prescription to the automatic pharmacy vending machine and no one ever has to see a real person.

Heck why do we need surgeons? They are already experimenting with robots doing surgery. Lets just automate everything.

Lets have robots take over the world!!!!!

I'll meet you by the campfire and make s'mores! I'll bring the marshmallows you bring the crackers?

 

[Old Timer]

First, let me say that I have nothing against pharmacists. I respect the years of training you go through, and the fact that just getting admitted to pharmacy school is extremely difficult.

However, as I understand it, pharmacists in a retail pharmacy basically dispense the meds as prescribed by a physician, and deliver verbal counseling when necessary. Occasionally, they may be required to act as a safety check to prevent harmful drug interactions.

In return for doing this, they are compensated about $100k a year or more.

Now, I don't understand why an advanced vending machine could not do all of the above functions, with 1/10 the total number of pharmacists employed.

The vending machine would use a pill counting robot that would use machine vision to make sure the correct pills are going into the bottle. Drug manufacturers could put a number stamped into every pill made to make it easier for a robot to scan them. A digital scale would make sure that the pill bottle has the exact number of pills, and a careful audit log complete with a video taken from a camera inside the machine showing the pills going into the bottle would be kept.

Prescriptions would be completely electronic. Computer software would check for possible drug interactions and overdoses using a conservative algorithm, with an actual pharmacist overriding it when necessary. When possible, instead of an actual pharmacist giving a verbal lecture, a pre-recorded video of an attractive actor would give the instructions verbally for the particular medicine.

Whenever an actual pharmacist is needed, a licensed pharmacist in a call center somewhere would log in via telepresence and communicate with the patient, and/or override the pill counting robot.

Right now, a setup this sophisticated might be too expensive for today's technology. However, over the next 30 years, it seems obvious that it would become incredibly cheap to do everything I just described.

If 9/10 retail pharmacists were replaced in this way, what would happen to the rest? Are there enough positions in clinical pharmacy or future jobs a pharmacy degree would qualify one for?

Yes, every industry will change with new automation, but it seems possible to automate much more of a retail pharmacist's job than the jobs of the other health professionals on these forums.

I'll be direct, you are either a troll or a *****. Let me know where you think you fall. This shows you have no clue what a pharmacist does. It's the human interaction, you nit wit. It's the look on the face of the lady that's too early for her Nitroglycerin refill. That lady had angioplasty the next day because a real live human pharmacist saw a real live human patient and was able to make an assessment. The doctor was contacted, the patient was sent to the ER and she is still alive today...... Machines can't replace people when the subjective is involved whether it is in Medicine or Pharmacy. No go back to trollville and leave us alone until we need to bail your ass out when you prescribe the wrong drug or the wrong dosage or some of the many errors we robots catch on a daily basis...

 

[ItsOverZyvox]

I think he's referring to making prescriptions digital. One day... there will be a machine that will take body temperature, take fluid samples, analyze symptoms and lab results, and consider all possible ailments and provide a solution. Oh, and there will probably be a machine that can cut with precision into a person's body to remove all the nasties too. I guess by then we'll all be out of a job and we'll sit around a campfire discussing the good ol' days when we criticized each others' professions. : /

Oh c'mon...I thought I would give a stupid response to a stupid question..

 

[bigpharmD]

First, let me say that I have nothing against pharmacists. I respect the years of training you go through, and the fact that just getting admitted to pharmacy school is extremely difficult.

However, as I understand it, pharmacists in a retail pharmacy basically dispense the meds as prescribed by a physician, and deliver verbal counseling when necessary. Occasionally, they may be required to act as a safety check to prevent harmful drug interactions.

In return for doing this, they are compensated about $100k a year or more.

Now, I don't understand why an advanced vending machine could not do all of the above functions, with 1/10 the total number of pharmacists employed.

The vending machine would use a pill counting robot that would use machine vision to make sure the correct pills are going into the bottle. Drug manufacturers could put a number stamped into every pill made to make it easier for a robot to scan them. A digital scale would make sure that the pill bottle has the exact number of pills, and a careful audit log complete with a video taken from a camera inside the machine showing the pills going into the bottle would be kept.

Prescriptions would be completely electronic. Computer software would check for possible drug interactions and overdoses using a conservative algorithm, with an actual pharmacist overriding it when necessary. When possible, instead of an actual pharmacist giving a verbal lecture, a pre-recorded video of an attractive actor would give the instructions verbally for the particular medicine.

Whenever an actual pharmacist is needed, a licensed pharmacist in a call center somewhere would log in via telepresence and communicate with the patient, and/or override the pill counting robot.

Right now, a setup this sophisticated might be too expensive for today's technology. However, over the next 30 years, it seems obvious that it would become incredibly cheap to do everything I just described.

If 9/10 retail pharmacists were replaced in this way, what would happen to the rest? Are there enough positions in clinical pharmacy or future jobs a pharmacy degree would qualify one for?

Yes, every industry will change with new automation, but it seems possible to automate much more of a retail pharmacist's job than the jobs of the other health professionals on these forums.

I am pretty sure I could automate 100% of a medical students responsibilities. I do know that you could not automate all the dumb mistakes and questions I have to fix and answer on a daily basis from medical students.

What about in medicine? Radiology will be gone in 10 years. Anesthesiology could easily be gone between CRNAs and automation. Like already stated surgery could be replaced by surgical robots, but you would need someone to run them (would it need to be an MD?).

 

[Aznfarmerboi]

First, let me say that I have nothing against pharmacists. I respect the years of training you go through, and the fact that just getting admitted to pharmacy school is extremely difficult.

However, as I understand it, pharmacists in a retail pharmacy basically dispense the meds as prescribed by a physician, and deliver verbal counseling when necessary. Occasionally, they may be required to act as a safety check to prevent harmful drug interactions.

In return for doing this, they are compensated about $100k a year or more.

Now, I don't understand why an advanced vending machine could not do all of the above functions, with 1/10 the total number of pharmacists employed.

The vending machine would use a pill counting robot that would use machine vision to make sure the correct pills are going into the bottle. Drug manufacturers could put a number stamped into every pill made to make it easier for a robot to scan them. A digital scale would make sure that the pill bottle has the exact number of pills, and a careful audit log complete with a video taken from a camera inside the machine showing the pills going into the bottle would be kept.

Prescriptions would be completely electronic. Computer software would check for possible drug interactions and overdoses using a conservative algorithm, with an actual pharmacist overriding it when necessary. When possible, instead of an actual pharmacist giving a verbal lecture, a pre-recorded video of an attractive actor would give the instructions verbally for the particular medicine.

Whenever an actual pharmacist is needed, a licensed pharmacist in a call center somewhere would log in via telepresence and communicate with the patient, and/or override the pill counting robot.

Right now, a setup this sophisticated might be too expensive for today's technology. However, over the next 30 years, it seems obvious that it would become incredibly cheap to do everything I just described.

If 9/10 retail pharmacists were replaced in this way, what would happen to the rest? Are there enough positions in clinical pharmacy or future jobs a pharmacy degree would qualify one for?

Yes, every industry will change with new automation, but it seems possible to automate much more of a retail pharmacist's job than the jobs of the other health professionals on these forums.

1. Drug monitoring whenever they come in for refills. (Just like how a physician doesnt need to do much physical besides taking a look at the patient, it is the same for us). We monitor for drug addiction, alcoholics, side effects, etc since we see them 1-2 times a month versus 1-2 times a year for a physician. I monitor a good percentage of my patients.

2. Making sure that all things are filled legally. Also making sure that they are filled in a way so that the insurance will pay you for it. Just like how you guys have paperwork, we have that too.

3. Monitoring for potential interactions especially for patients who see 2-3 doctors and are poly-pharmacy.

4. Customer service so that the patient will come back.

Those are just a few of the things that robots cannot do.

 

[PumpkinSmasher]

Is the robot going to answer the bagillion OTC/supplement questions that are asked everyday?

 

[fhx06]

The doctors want to do it all... you know, take those odd questions about flavored suppositories and things like that. 😉

 

[PumpkinSmasher]

The doctors want to do it all... you know, take those odd questions about flavored suppositories and things like that. 😉

Root beer suppositories are my personal favorite.

 

[fhx06]

Root beer suppositories are my personal favorite.

Really? Hmm. That almost makes me not want to eat my lunch. Almost.

So basically, no campfire and s'mores?

 

[Quiksilver]

I gotta keep pushing this robot insurance thing don't i?
http://www.hulu.com/watch/2340/saturday-night-live-old-glory

they attack old people, not help them. argh, what do they teach you in med school?

On that note, think about this, in a traditional retail setting, its the professional judgement that comes into play. The idea on knowing when one can be conservative and when not to be. The idea of knowing how really "serious" an interaction can be. As a med student, I am pretty sure you have not had any contact with a pharmacist, but when you do, I am positive your ass will be saved countless of times because Epocrates told you to do something that you shouldn't have and the pharmacist caught it. So much for automation right?

Others have mentioned the idea that people need to talk pharmacists for all their advice concerning insurance policys, laws, recommendations, OTC/herbal usage, this is all true. Can you imagine not having someone in the pharmacy there everytime a problem arises with a prescription, or insurance? Customer satisfaction will plummet!

How do med students and doctors feel about WebMD diagnosing the patients themselves, and having to argue that with a patient, why they think they have gastric cancer and its only heartburn (just, like epocrates, the computer told them so). Or better yet coming in to tell YOU what medications they should recieve because they have depression, ED, restless leg syndrome or countless other diseases. Do you see the problem with this scenario? If our job can be marginalized, so can yours!

 

[PumpkinSmasher]

I gotta keep pushing this robot insurance thing don't i?
http://www.hulu.com/watch/2340/saturday-night-live-old-glory

they attack old people, not help them. argh, what do they teach you in med school?

On that note, think about this, in a traditional retail setting, its the professional judgement that comes into play. The idea on knowing when one can be conservative and when not to be. The idea of knowing how really "serious" an interaction can be. As a med student, I am pretty sure you have not had any contact with a pharmacist, but when you do, I am positive your ass will be saved countless of times because Epocrates told you to do something that you shouldn't have and the pharmacist caught it. So much for automation right?

Others have mentioned the idea that people need to talk pharmacists for all their advice concerning insurance policys, laws, recommendations, OTC/herbal usage, this is all true. Can you imagine not having someone in the pharmacy there everytime a problem arises with a prescription, or insurance? Customer satisfaction will plummet!

How do med students and doctors feel about WebMD diagnosing the patients themselves, and having to argue that with a patient, why they think they have gastric cancer and its only heartburn (just, like epocrates, the computer told them so). Or better yet coming in to tell YOU what medications they should recieve because they have depression, ED, restless leg syndrome or countless other diseases. Do you see the problem with this scenario? If our job can be marginalized, so can yours!

Do we really need doctors for primary care out in the community or do we just need PAs and NPs with a couple doctors for consults...

 

[GeraldMonroe]

Responses :

"If drug dispensing can be automated, why not all of medicine" :
The difference between dispensing drugs securely to the person they are prescribed to and making medical diagnoses is that it's possible to design a machine to do the first one with state of the art engineering. It is not possible to build even a prototype of the artificial intelligence that would be required to replace even an FP. I do agree that, in theory, all human jobs could be automated, but it will require many more generations of technology before it will appear feasible. However, I do agree about the other roles of pharmacists mentioned here : it isn't possible to build a machine that can answer OTC questions or spot clinical symptoms of side effects in a patient that walks up to the counter. Perhaps 9/10 retail pharmacists being replaceable is an overestimate.

"Hackers would break the system" :
ATM machines already handle millions of dollars in cash, which has at least as much theft potential as scheduled drugs, right? Some of these $100,000+ vending machines could be secure enough to dispense a scheduled med, although a patient would probably have to submit to an iris scan or a fingerprint scan.

Thank-you for your input, I'm glad I understand more about what a pharmacist does. I think the vending machine idea will eventually happen, with machines located at corner drugstore pharmacies with larger facilities with human staff located at big, central pharmacies. However, it would be a hybrid approach, with many of the machines remotely monitored by a PharmD. It might relieve the current shortage of pharmacists and stagnate pay a little, but probably would not crash the job market like I thought.

I'm sorry for the tempers I may have inflamed. The reason I wrote the post above is that I majored in computer engineering. I know a part of what a pharmacist does is make sure that a legitimate prescription is filled with the correct drug and given to an authorized person. (the techs usually count the actual pills)

As an engineer, I feel like I could build a machine so secure that mistakes almost never happened. An iris, fingerprint, or RFID scanner would verify a patient's identity (a patient would go to a human run facility and present ID in order to be scanned into the system). Software would automatically check dosages and drug interactions. Physicians would log on to a secure website using a smartcard and one time pad encryption to put a prescription into the system. Several digital cameras would monitor the pill tray as the pills came out of the hopper in the machine, and redundant computers would check for a code physically stamped into each pill using machine vision. The plastic pill bottles would be attached to a multi-cell digital scale, and there would be several layers of checks for accuracy. The video of the pills going into the bottle and the bottle heading out to be picked up by the patient would be stored permanently in a repository somewhere, so that it would be possible to protect the owners of the machine from liability with hard evidence.

The vending machine would have at least 2 oder filling robots inside, and 2 separate control computers, so that if one failed, the machine could continue working until someone came to repair it.

 

[PumpkinSmasher]

Responses :

"If drug dispensing can be automated, why not all of medicine" :
The difference between dispensing drugs securely to the person they are prescribed to and making medical diagnoses is that it's possible to design a machine to do the first one with state of the art engineering. It is not possible to build even a prototype of the artificial intelligence that would be required to replace even an FP. I do agree that in theory, all human jobs could be automated, but it will require many more generations of technology before it will appear feasible. However, I do agree about the other roles of pharmacists mentioned here : it isn't possible to build a machine that can answer OTC questions or spot clinical symptoms of side effects in a patient that walks up to the counter. Perhaps 9/10 retail pharmacists being replaceable is an overestimate.

"Hackers would break the system" :
ATM machines already handle millions of dollars in cash, which has at least as much theft potential as scheduled drugs, right? Some of these $100,000+ vending machines could be secure enough to dispense a scheduled med, although a patient would probably have to submit to an iris scan or a fingerprint scan.

What is your viewpoint on NPs and PAs taking over primary care in the community?

 

[GeraldMonroe]

What is your viewpoint on NPs and PAs taking over primary care in the community?

It's inevitable, for the same reason that automated pharmacies are probably inevitable. Fact is, primary care Family Practice physicians train by rotating through each specialty over a 3 year period.

Here's a curriculum for a family practice residency program : Hematology/Oncology 4 weeks Cardiology 4 weeks Urology/Nephrology 4 weeks Neurology 4 weeks OB/Labor & Delivery 4 weeks Orthopaedics 4 weeks Outpatient Pediatrics 8 weeks Psychiatry 4 weeks Clinical Seminars 8 weeks Gynecology 4 weeks Electives 4 week

That's year 1, and years 2 and 3 are similar.

Well, a PA does a comparable set of core rotations similar to third year of medical school. They then may work for years in a single field.

So the way to use PAs and NPs in primary care is obvious.

A big clinic would have several physicians for legal reasons and for handling anything the PAs have trouble with. The physicians would also be there for complex, multi-disorder cases.

Then, there would be a PA/NP specialist or two for each one of the specialties handled in primary care. You could have a psych issues PA, an endocrinology one, a peds PA that would check healthy kids for growth, a PA that did neurology screenings and followup visits, a gyn PA to do pap smears, a respiratory medicine PA to monitor asthma patients, ect.

A family practice doctor is allowed do all of those things above, and more, up to a certain level of complexity. Basically you are splitting that one job into about 5 or 10, and using the FPs only when their more in depth training is really necessary.

Yes, the clinic would be more complicated, but I think it's inevitable because the cost of each NP/PA is roughly half what a physician costs. Paying a manager or two to keep this 'goat rodeo' running would still leave lots of money saved. I think some clinics, especially urgent care centers, already basically work this way. That's another change : if you have 15 or so healthcare providers in one clinic, rather than just 1, the law of averages means that there will be less fluctuation in total patient load. So, you could make the clinic much more 'on demand', with less need for appointments.

By the way, the arguments that medical students make against these changes are almost verbatim what some of the angrier pharmacists and pharm students have said.

 

[bigpharmD]

Responses :

"If drug dispensing can be automated, why not all of medicine" :
The difference between dispensing drugs securely to the person they are prescribed to and making medical diagnoses is that it's possible to design a machine to do the first one with state of the art engineering. It is not possible to build even a prototype of the artificial intelligence that would be required to replace even an FP. I do agree that, in theory, all human jobs could be automated, but it will require many more generations of technology before it will appear feasible. However, I do agree about the other roles of pharmacists mentioned here : it isn't possible to build a machine that can answer OTC questions or spot clinical symptoms of side effects in a patient that walks up to the counter. Perhaps 9/10 retail pharmacists being replaceable is an overestimate.

"Hackers would break the system" :
ATM machines already handle millions of dollars in cash, which has at least as much theft potential as scheduled drugs, right? Some of these $100,000+ vending machines could be secure enough to dispense a scheduled med, although a patient would probably have to submit to an iris scan or a fingerprint scan.

Thank-you for your input, I'm glad I understand more about what a pharmacist does. I think the vending machine idea will eventually happen, with machines located at corner drugstore pharmacies with larger facilities with human staff located at big, central pharmacies. However, it would be a hybrid approach, with many of the machines remotely monitored by a PharmD. It might relieve the current shortage of pharmacists and stagnate pay a little, but probably would not crash the job market like I thought.

I'm sorry for the tempers I may have inflamed. The reason I wrote the post above is that I majored in computer engineering. I know a part of what a pharmacist does is make sure that a legitimate prescription is filled with the correct drug and given to an authorized person. (the techs usually count the actual pills)

As an engineer, I feel like I could build a machine so secure that mistakes almost never happened. An iris, fingerprint, or RFID scanner would verify a patient's identity (a patient would go to a human run facility and present ID in order to be scanned into the system). Software would automatically check dosages and drug interactions. Physicians would log on to a secure website using a smartcard and one time pad encryption to put a prescription into the system. Several digital cameras would monitor the pill tray as the pills came out of the hopper in the machine, and redundant computers would check for a code physically stamped into each pill using machine vision. The plastic pill bottles would be attached to a multi-cell digital scale, and there would be several layers of checks for accuracy. The video of the pills going into the bottle and the bottle heading out to be picked up by the patient would be stored permanently in a repository somewhere, so that it would be possible to protect the owners of the machine from liability with hard evidence.

The vending machine would have at least 2 oder filling robots inside, and 2 separate control computers, so that if one failed, the machine could continue working until someone came to repair it.

...you my friend...are a tool

 

[PharmDstudent]

Really? Hmm. That almost makes me not want to eat my lunch. Almost.

So basically, no campfire and s'mores?

Stop being so cute! 😀

 

[fhx06]

Stop being so cute! 😀

Totally am not; I just have a thing for campfires and s'mores. It's going to be the next roundtable; you'll see. Healthcare forums will one day take place on a beach with representatives debating things over a nice, cold drink and s'mores.

 

[Quiksilver]

webMD does all the diagnosing for you. By your same logic, we can get rid of a majority of PA,NP,MDs because well we can have 1 or 2 to sign off on it and answer questions. Throw clinical judgement out the door. All you guys do is diagnose by algorithms. Algorithms can be handled on computers

To be honest, pharmacy is shifting towards robots and automation. You are right, the amount of community pharmacists will not forever increase and we probably are reaching a plateau rapidly. However, My opinion is you are going to see a lot more of us. I think the shift in pharmacy is going to put up in other "outpatient type" settings, such in those clinics. Look over PA, NP and consult with MDs. Do most of the therapeutic drug monitoring in these big clinics. And they are already there in some places, their roles will become bigger and appear more frequent. Drugs and disease states can be monitored and cared for more closely with us.

 

[Pharmacy Kid]

Hmm, is it just me or are some of us overreacting? From the view of an outsider, he gives an accurate description of what a pharmacist seems to do.

Even though the majority of a pharmacist's job is to verify, there are little complex things that a machine can't do. I doubt a machine can answer a random question about an OTC. Also, you lack continuity of care when you have a satellite pharmacist answering questions. I can almost gaurentee once you implement these machines, the number of adverse drug effects will increase.

Like you said, this probably won't happen for at least a decade so I'm not worried.

 

[confettiflyer]

Well look at radio, we've had the technology for at least a decade to automate everything and have a few DJ's voice tracking their programs across the country. Stations that went DJ-free w/satellite radio are starting to put them back into rotation, so there's probably a human element to it.

What we'd probably see in retail pharmacy is a contraction and consolidation of services in low traffic areas, central fill, with automated systems filling the gap. That new robot looks interesting (with the video and all). I think we'll see this within a generation as mine is extremely comfortable with automation.

I mean...my PCP e-transmits the script to the pharmacy, it gets filled...I show up and have some minimum wage clerk pull it off the shelf. I don't see the difference in just swiping ID and having the thing come out of a machine. It'll still be verified by an RPh, but the technology is there that this can be done remotely.

That's an ideal case, and the need for judgment comes in with every other script that comes in. So in a way, I think you'll see both....automated/centralized fill will be incentivized (like e-prescribing or mail order now) and handle the bulk of the transactions, but you'll still have the RPh & techs there to handle errors/use judgment. If you have 4 stores within a geographic area, 3 will go "automated" only while 2 will retain staff as "full service pharmacies." We're seeing blips of this now with POWER in FL (central fill), e-scripts dumping into your fulfillment software automatically, the push for automatic refills, EHR's, and auto dispensing machines. If someone can connect it all together, they'll be prety darn rich.

What do you guys think? Am I just way off here? Trying to balance the "robots will take over" idea with the "you need a live pharmacist for everything" idea.

 

[grizzlesgrizzlies]

When you watch CVS/Walgreens/other pharmacy ads on TV, what do they promote/advertise? Their professional, caring, human pharmacists.

Even with ATMs seemingly around every corner, how does that explain why do bank tellers still exist?

 

[DrugRX]

The most challenging part of developing software is handling the exception. If there are no predictable boundaries, manual process is inevitable. We are dealing with human beings, and we will never be able to read people's mind (doctors and patients). Many people will constantly try to break the rules, so we have to deal with it and set-up new rules every so often. No matter how sophisticated software we create, it won't be enough to cover the exceptions, and constant updates and changes are necessary.

Can it be done? Anything can be done if you have time and money. However, I doubt that even a complete automation can replace pharmacist.

Also, you don't want to say that it is easier to automate retail pharmacist's job than the jobs of the other health professionals because there are a lot more exceptions/scenarios retail pharmacist handle than you can think of. Plus, if you say it is easy to automate retail pharmacist's job, most of other health professional's job is as easy per programmer's viewpoint.

 

[PharmDstudent]

Totally am not; I just have a thing for campfires and s'mores. It's going to be the next roundtable; you'll see. Healthcare forums will one day take place on a beach with representatives debating things over a nice, cold drink and s'mores.

That would be nice...

 

[powertoold]

Honestly, it's difficult to say at this point. I'm sure you can automate almost everything a retail pharmacist does, but that's where automation fails - not everything can be done. Plus, a pharmacist HAS to be present in order to supervise the robot. The law won't let a robot or computer program be liable for a mistake.

GeraldMonroe, I think you're asking for too much. I don't think you want a robot that can do everything a pharmacist does... what you want is a robot that will do a pharmacist's job very well. When this robot is conceived, many retail pharmacists will lose their job 🙁 I can see the day!

Unfortunately, this will also be the day that a robot will take over a lot of a physician's diagnostic ability. Trained nurses will input symptoms and complexions into the robot, and the robot will come up with the most likely diagnosis. By this point, studies will show that the robot is more consistent at diagnosing than physicians who see 30 patients a day and work 60 hours a week.

It's a sad future for us 🙁 The robots will take over.

 

[powertoold]

I'm not sure if any of you have played this game yet, but it shows how powerful a computer medical diagnostic algorithm can potentially be:

http://en.akinator.com/

Basically, you think of any character (real or fiction) and answer all the questions truthfully, and it will come up with your character 🙁 The same can be applied for symptoms, lab results, etc. etc.

Also, if you've read the book Complications by Atul Gawande MD, Dr. Gawande talks about a computer program that analyzed EKGs better than a renowned EKG expert!

 

[jmoini]

As an engineer, I feel like I could build a machine so secure that mistakes almost never happened. An iris, fingerprint, or RFID scanner would verify a patient's identity (a patient would go to a human run facility and present ID in order to be scanned into the system). Software would automatically check dosages and drug interactions. Physicians would log on to a secure website using a smartcard and one time pad encryption to put a prescription into the system. Several digital cameras would monitor the pill tray as the pills came out of the hopper in the machine, and redundant computers would check for a code physically stamped into each pill using machine vision. The plastic pill bottles would be attached to a multi-cell digital scale, and there would be several layers of checks for accuracy. The video of the pills going into the bottle and the bottle heading out to be picked up by the patient would be stored permanently in a repository somewhere, so that it would be possible to protect the owners of the machine from liability with hard evidence.

The vending machine would have at least 2 oder filling robots inside, and 2 separate control computers, so that if one failed, the machine could continue working until someone came to repair it.

at work, there are so many pop ups about possible drug interactions/warnings that we just breeze through because they're false warnings and the pharmacist (human, not robot) knows which ones are actually important. what will a computer do when it gets warnings all the time? not dispense the med? also, what about people who pick up meds for their mom/dad/family member/friend? how will the comp verify? how will the comp interpret human input on how the drugs are affecting the patient, and what will the comp do? what will the comp do with insurance issues? how will it know who is shopping numerous doctors/pharmacies? how will it talk to robots of competing pharmacies? etc, etc.

you make inflammatory statements lightly and devise ways to eliminate the field of fellow current and future health professionals. how can those of us in the pharmacy field not take offense to this?

i'm gonna ask my engineer friends to devise ways to automate diagnosis/surgery etc. and post this is in med forums. you get paid way to much and charge too much for the work you do anyway, money that could go towards better things and less arrogant people

 

[powertoold]

at work, there are so many pop ups about possible drug interactions/warnings that we just breeze through because they're false warnings and the pharmacist (human, not robot) knows which ones are actually important. what will a computer do when it gets warnings all the time? not dispense the med? also, what about people who pick up meds for their mom/dad/family member/friend? how will the comp verify? how will the comp interpret human input on how the drugs are affecting the patient, and what will the comp do? what will the comp do with insurance issues? how will it know who is shopping numerous doctors/pharmacies? how will it talk to robots of competing pharmacies? etc, etc.

I think a robot can work to reduce a lot of pharmacists. GeraldMonroe just overstated the potential job loss.

We can imagine call centers for people to call about any drug effects. The robots will be able to fill scripts faster than any pharmacist, and companies will only need one pharmacist around for each robot. Any uncommon problem will be dealt with by the pharmacist responsible for the robot.

Anyway, it's all hypothetical. I don't think there's any doubt that automation and efficient central facilities will replace some pharmacists, but the potential damage to the profession is still uncertain.

 

[WVUPharm2007]

http://en.akinator.com/

!

Creepy. It got Stanley Kubrick in like 17 questions.

 

[FORTLIVINGROOM]

If 9/10 retail pharmacists were replaced in this way, what would happen to the rest? Are there enough positions in clinical pharmacy or future jobs a pharmacy degree would qualify one for?

Why do you think Pharmacists are pushing for Limited Prescriptive Authority!?!?!?



Most Pharm.D.'s can dose chronic conditions just as well if not better than any NP or MD. Anti-coag, HTN, DM, you name it. The only thing holding us back is real-time or recent laboratory data. Regardless, we'll have electronic access to any and all labs we need before any machines can take our job...guaranteed.

You know your buddies MD egos can't stand titrating ACEIs and BB's for 40 yrs.

We will be the "limited" PCP...competing with NP's, and you guys can have all the fun stuff that you all want to specialize in and make the big bucks. We all know how great the US healthcare system currently is with you guys doing the dosing and counseling. And people wonder why adherence rates are only 50%!?!?!?!?!?



So here is the current US model:

Awesome google-bypass you just performed Dr. CardiologistSoIMake$500K/yr!!!

<pats self on back>

Meanwhile, pt never even had a BP<160/100. AWESOME!!!

Good job treating that anemia of CKD Dr. HematologistIMake$500K/yr!!!

<pats self on back>

Ooopsie, looks like the pt never had a BG under 200 in the past 10 yrs. AWESOME!!!



Some RPh's may just be dispensers now, but take away their jobs and see how quick they come up with accelerated clinical courses to "refresh" them. They'll come right after your piece of the pie!😉

 

[eightball]

nevertheless,

for whatever the pharmacy profession is worth, its shouldnt take 4 years, a doctorate and roughly $100,000

I am only half way through and with my tech experience, some therapeutics and pharmacology, I perform as a full fledged pharmacist(retail+ long-term-care).Of course with a good drug software to look things up when Im in doubt. Not as confident yet with hospital.

seriously, retail pharmacy? 90% of it should be automated

 

[FORTLIVINGROOM]

seriously, retail pharmacy? 90% of it should be automated

Who knows...maybe POWER will help RPh's have more free time to do more counseling...I guess we'll see. Right now, all anyone is getting are pink slips.

I can only assume pharmacists will be storming state capitols and demanding reimbursement for clinical services or demanding prescriptive authority if more layoffs happen.


The thing is...the chains keep the employed ones too busy to do any of this stuff...while the laid-off ones don't have the means.

 

[GeraldMonroe]

I'm not trying to be inflammatory, I'm sorry if I come across that way. But if a job is so repetitive and simple that a machine could do it, it should be. Human labor should be reserved for where it is needed, and ultimately that's what happens. I had to work as a cashier in high school, and absolutely hated it. I wish no-one had to work jobs like that, and robots did all of them. A robotic cashier is more than practical with today's technology, especially if all the items in the store were labeled with RFID tags.

Thus, I asked what pharmacists actually do that a machine can't do. I just read that many hospitals already have fully automated robots that can fill scripts, as well as dispensers located on each floor with the drugs in them. Yet, hospitals still employ pharmacists.

 

[eightball]

gerald...
i still think your view of pharmacy as a profession is too simplistic in its contribution to healthcare in general. Key word, Healthcare.

Do some research and come back.

In such a free nation, capitalistic at best, I would say society pays pharmacists pretty heftly for licking and sticking, dont you think?

 

[Taurus]

Here are some recent articles posted on this forum on this topic:

Push-button pill-popping kiosk tested at hospital

Robo-pharmacy​

If you do an internet search, you can find many articles on this. This and the unfettered expansion of pharm schools are understandably sensitive subjects for pharms.

 

[ItsOverZyvox]

Push-button pill-popping kiosk tested at hospital

If you do an internet search, you can find many articles on this. This and the unfettered expansion of pharm schools are understandably sensitive subjects for pharms.​

​

Except internet sometimes doesn't always pull up pertinent info for the US. But it's interesting note that current temperature in Ontario is -1C.

 

[GeraldMonroe]

Yes. This machine is precisely what I am describing, down to the last detail. http://www.thestar.com/News/GTA/article/606550

It's using RFID tags to identify the drugs by the bottle they are in, and I'm suggesting using a system that could identify the drugs by pill, in order to avoid any chance of a mistake. It uses a real pharmacist elsewhere who approves the order, and who could monitor 5 or 10 of these machines at a time rather than work just one drugstore.

In any case, I'm asking what happens
to the pharmacists this machine displaces?

 

[Old Timer]

If you think there is a computer or a robot that can replace the human element of any aspect of health care, as opposed to the mechanical aspects you are sadly mistaken.

Just like in the example I gave above, there is no robot or kiosk that would have prevented that woman from having a heart attack. It was a human being with knowledge of another human being in face to face contact that was the factor and that can never be replaced. In the same way, an algorithm can never replace a physician.

 

[eightball]

Taurus,
You will never eliminate the human element out of the equation, no matter what.

Pharmacist demand may decrease, the pay might be placed on the chopping block, but the fact remains, you NEED a pharmacist in the continuum of clinical care.

And no, I am not sensitive about all the pharmacy-demise-hullabaloo...market forces shape everything, including medicine. Your belief that a robot can replace a pharmacist entirely is laughable.

 

[GeraldMonroe]

eightball : I said in my original post that I think a robot might be able to reduce the number of retail pharmacists needed to one half to one tenth the current number. It depends on how much babysitting the robots end up requiring, and how much they cost.

 

[MdBrndPhrmcst]

[QUOTE

Now, I don't understand why an advanced vending machine could not do all of the above functions, with 1/10 the total number of pharmacists employed.
[/QUOTE]

Can a machine sexually harrass the cute pharmacy technician? nooooooo.... that takes a soul.

 

[eightball]

Here are some recent articles posted on this forum on this topic:

Push-button pill-popping kiosk tested at hospital

Robo-pharmacy​

If you do an internet search, you can find many articles on this. This and the unfettered expansion of pharm schools are understandably sensitive subjects for pharms.

eightball : I said in my original post that I think a robot might be able to reduce the number of retail pharmacists needed to one half to one tenth the current number. It depends on how much babysitting the robots end up requiring, and how much they cost.

you do have a point, but for all practical purposes, we live in highly regulated, sue-happy society. It will need a pharmacist to physically approve of everything the robot spits out.

One misstep on a coumadin delivery to a visually impaired, semi-educated, drunk joe may cause some serious side effects.

All utopian logic/BS aside, it will be very hard to reduce the pharmacist workforce by a significant number. The pay and demand might suffer, however.

 

[bigpharmD]

Here are some recent articles posted on this forum on this topic:

Push-button pill-popping kiosk tested at hospital

Robo-pharmacy
​

If you do an internet search, you can find many articles on this. This and the unfettered expansion of pharm schools are understandably sensitive subjects for pharms.

what about the unfettered expansion of DO schools, carribean schools, international grads swooping in for the paycheck, the almight DNP, PAs and the list goes on. Or what about the surgical robots, CRNAs, and socialized medicine. Do a google search on that. Whats it feel like to go through 4 years of UG, 4 years of med school, 3-4 years of residency and not know what it is going to look like when you get done while having 200,000 dollars in debt?

I am not too worried about my job considering my paycheck comes from the same place as the surgeons I work with. He hired me...

 

[bigpharmD]

I'm not trying to be inflammatory, I'm sorry if I come across that way. But if a job is so repetitive and simple that a machine could do it, it should be. Human labor should be reserved for where it is needed, and ultimately that's what happens. I had to work as a cashier in high school, and absolutely hated it. I wish no-one had to work jobs like that, and robots did all of them. A robotic cashier is more than practical with today's technology, especially if all the items in the store were labeled with RFID tags.

Thus, I asked what pharmacists actually do that a machine can't do. I just read that many hospitals already have fully automated robots that can fill scripts, as well as dispensers located on each floor with the drugs in them. Yet, hospitals still employ pharmacists.

Because I have to fix all of your wrong F'in orders all day. I will always have a job. For example, what about the order from the neuro resident today for factor Vii at a dose of 90 mcg/kg in a new liver transplant to pull a bolt out even though the INR is 1. What if that patient would have clotted off the hepatic artery in the new liver? Not to mention the 7,000 dollars I saved the hospital. Or what about the other day when they started daptomycin to treat a staph pneumonia? That will work REALLY well.

If you are so great at ordering antibiotics why are our antibiograms all showing resistance patterns and we need stewardship programs staffed by pharmacists to hold your hand?

If we are so worthless why are our transplant nephrologists hiring a pharmacist to work in their clinic??

Who do think makes all of the order sets that you still seem to screw up?

What about when you are at home or at clinic but 6 nurses have medication related questions but they come ask me so you dont have to be paged 6x.

Those robots do nothing but take technician jobs away. You have no clue and I would enjoy pimping you out all day...

 

[Doctor M]

Because I have to fix all of your wrong F'in orders all day. I will always have a job. For example, what about the order from the neuro resident today for factor Vii at a dose of 90 mcg/kg in a new liver transplant to pull a bolt out even though the INR is 1. What if that patient would have clotted off the hepatic artery in the new liver? Not to mention the 7,000 dollars I saved the hospital. Or what about the other day when they started daptomycin to treat a staph pneumonia? That will work REALLY well.

If you are so great at ordering antibiotics why are our antibiograms all showing resistance patterns and we need stewardship programs staffed by pharmacists to hold your hand?

If we are so worthless why are our transplant nephrologists hiring a pharmacist to work in their clinic??

Who do think makes all of the order sets that you still seem to screw up?

What about when you are at home or at clinic but 6 nurses have medication related questions but they come ask me so you dont have to be paged 6x.

Those robots do nothing but take technician jobs away. You have no clue and I would enjoy pimping you out all day...

very well said...

 

[Old Timer]

eightball : I said in my original post that I think a robot might be able to reduce the number of retail pharmacists needed to one half to one tenth the current number. It depends on how much babysitting the robots end up requiring, and how much they cost.

Stick to medicine. Just how many scripts can your robot fill per day? How much does your robot cost? How much does it cost to operate your robot? How does your robot do prospective drug reviews for new patients? I doubt if this will effect the demand for pharmacists at all. How are you going to change the laws in all 50 states that require a pharmacist be in the pharmacy?

Are you sure you got into medical school? You may be educated, but your really pretty dumb. You don't see the larger picture. I repeat and I will bow out after this, automation will replace mechanical operations by human beings in many fields including health care. Automation and robotics will never replace direct human contact in health care including pharmacy. In the hospital setting, using robots instead of pharmacists and letting the doctors do what they want would kill so many people so fast the administrators would bring us back in a heart beat.

Medicine, pharmacy and dentistry are called the healing arts because there is as much art as there is science. Any practitioner with experience would understand that. You will understand that too when you have some actual experience. When you are on rounds and you reach out to a pharmacist to save your ass when you have no clue as how to prescribe something and the robot says:
"That does not compute."

 

[fhx06]

Dang this only illustrates the misconceptions between professions and only fuel the hostilities between professionals. Everyone needs to keep their ego in check and realize that the thing you are arguing about boils down to a human life, one that is trusting all of us to work together to make sure his or her life will not falter unnecessarily. We can sit here and point out why we don't need this-and-this professional or argue about each others' faults until the end of the world, but every aspect of healthcare needed from the surgeons to the person cleaning up the messes of the day.

WE ARE ALL HEALTHCARE PROFESSIONALS. Act like it.