An area of great progress in Healthcare technology has been the wide adoption of automated dispensing cabinets for medications and supplies in hospitals and other healthcare facilities. This technology employs the use of storage units that operate somewhat like vending machines for the medical products, but also have sophisticated software on the back-end that handles patient orders, medication dosing documentation, inventory management, and billing transactions. This post will cover automated dispensing cabinets as well as centralized pharmacy automation products.
Medication Dispensing Systems
In a hospital or other clinical setting, the units are installed at most units where patients are seen, such as General Medicine, ICU, the OR, and the ER. Supplies and/or meds are enclosed in the cabinets that are locked until the clinician accesses them. Here are the typical steps taken for a medication transaction:
- Physician enters an order for a medication in an electronic medical records (EMR) system
- The order is transmitted electronically to a server that manages communication to all of the dispensing cabinets
- Because the dispensing system gets patient information from the hospital’s registration system, it knows where all the patients are located
- The order is routed to the correct dispensing cabinet on the nursing floor
- A clinician such as a nurse goes to the dispensing cabinet:
– User logs into the cabinet with either a badge reader or fingerprint scanner. Older versions required a User ID and password typed in
– User selects the correct patient name
– User selects the order for the medication
– The correct drawer or door on the cabinet opens, giving them access to the medication
– When done, the user closes the drawers or doors on the dispensing cabinet and logs off
- They will then administer the med to the patient. At this point, they may use a barcode reader at the bedside to scan the med and the ID bracelet of the patient to ensure they have the right med and patient
- An administration message will transmit back to the server, and then back to the EMR, showing a complete administration
- Another transaction will probably be created by the EMR to generate a charge for the med.
- Yet another transaction is generated for the pharmacy or Central Supply department that decrements the amount on hand in the cabinet. That count will be calculated toward a refill report to replenish the cabinet with supplies and meds.
A physician order is not required for some medical supplies, so when those are dispensed, the user just logs into the cabinet, then selects the patient and supplies. Also, some supplies are tracked under “floor stock” because they are general use supplies.
Automated Dispensing Cabinets Manufacturers
When looking at this market, we should consider that there are several product lines, including:
- Medication dispensing, administration, and management
- Supply distribution and management
- Cath Lab supplies
- Anesthesia carts
- Health Data Analytics
For purposes of this article, I’ll focus mostly on the medication and supply management products.
The market leader for automated medication management is Pyxis Corp, based in San Diego. They were fortunate to be the first to the game with their MedStation products in 1990. They wasted no time in penetrating the hospital market with their first generation MedStations, and many hospitals have remained loyal and grown along with Pyxis. In the mid-1990s, Pyxis launched their SupplyStation line to manage the medical supply chain. This technology was initially built as an extension of their medication products, but was not nearly as successful, as supplies shouldn’t really be managed like medications. In 1996, Pyxis was acquired by Cardinal Health. Their growth continued, and they maintained between 60-70% of the market share for pharmacy dispensing systems that continues to now. In 2009, Cardial spun off clinical and medical product divisions, including Pyxis to form CareFusion. Then CareFusion was sold to Becton Dickinson in October 2014. In spite of the multiple buyouts, Pyxis has managed to stay fairly strong in the market.
Randall Lipps had a child who was hospitalized at birth. As he kept vigil at the hospital, he noted the inefficiencies of the medical supply process. Taking input from nurses, and using his technical and operational background, he formed Omnicell in 1992. The first product line was the OmniSupplier cabinets. While the early Pyxis SupplyStations secured supplies as if they were medications, Omnicell saw that supplies needed a different workflow. The OmniSuppliers had clear Plexiglass-like panels on most sides, making it easier to see supplies. They also made it faster to get in, get supplies, and log out, and used a patented “guiding lights” technology to help users locate supplies in the cabinets.
While Omnicell began in the supply management side, they did not get into medication dispensing systems until 1996. Like Pyxis, they have launched or acquired other pharmacy automation products, such as anesthesia carts and central pharmacy systems. They have also acquired a healthcare analytics solution called Pandora, MACH4 Pharma Systems of Germany. Their newest acquisition was the AcuDose products in January 2016. Of the three largest vendors in this industry, they are the only one to retain their original corporate structure. Disclosure: I worked for Omnicell from 1995-1999.
AcuDose is the third largest pharmacy automation product line. They were originally formed as Automated Prescription Systems, Inc. of Pineville, La, and were acquired by McKesson in 1998. McKesson then sold off the business to Aesynt in 2013. Then they were sold yet again to Omnicell in January 2016. Their dispensing units have been recently redesigned, and offer a feature that allows nurses to hold their place in the workflow if they get interrupted and have to come back later. When the user logs back in, the system remembers where they left off. AcuDose also has the ROBOT-Rx central pharmacy automation product, which is covered in the next section.
A newcomer that could actually turn out to be a game-changer is the RxStation system from Cerner. Cerner is one of the largest providers of enterprise EMR and clinical documentation software. What sets RxStation apart from the others is that it was developed by a major software vendor, built as an integrated solution on top of an existing product. Cerner claims that no interfaces are needed, as the dispensing cabinets are integrated with the Millennium products.
Capsa Healthcare is an Oregon based provider of automated medication carts, computing workstations, and pharmacy automation. Capsa proposes to have the best security for managing controlled medications, STAT/first doses and e-kits. Their hardware supports medications in a variety of packaging, from unit dose to punch cards and bulk supplies. They also have two robotic centralized pharmacy packaging machines.
Automated Dispensing Cabinets Workflow
Here is a diagram that covers many of the functions that occur in the course of operating automated medication dispensing units.
I’m going to switch gears from the point-of-care units to cover centralized pharmacy automation. This is a technology solution used in retail as well as hospitals and regional pharmacies that serve nursing homes and other long term care locations. Whereas the dispensing cabinets are used for Stat meds and orders written at the point of care, the centralized units are for longer term med orders. The units tend to be large, covering a good portion of the floor in a central pharmacy. They run continuously, creating packaged units of meds per patient, complete with a barcode dosing label and instructions. The packages then get delivered to the correct nursing unit or facility. They have the advantage of helping to manage large quantities of medications, and perform conflict and allergy checking.
Unlike the medication dispensing cabinets, the market of central pharmacy robots is more crowded. Some of the other suppliers of this technology are AmerisourceBergen, Dossette, and RxSafe.
Automated Dispensing Cabinets Comparison
|Pyxis||First to market, loyal customer base, deep operational knowledge, strongest in medication systems||Weaker in supply management products|
|Omnicell||Advanced technical expertise, Guided Lights feature, broad integrated product line, original corporate structure remains||Relatively low medication systems market share|
|AcuDose||Products recently re-engineered, “hold my place” feature, strong ROBOT-Rx product||Before being acquired by Omnicell, they were a distant third in market share. Not an issue now|
|Capsa||Claims to be more affordable than the larger ADC providers||Not a broad offering of products|
Pharmacy Automation Benefits
- Increased charge capture
- Lower inventory costs
- Reduction of stock-outs
- Increased patient safety via bar code verification
- Increased satisfaction of users from more organized inventory
Here are some case study numbers for the top three vendors:
- CHRISTUS Spohn Health System saw a 62.5% reduction in the medication pick process using Pyxis automation
- South Jersey Healthcare System lowered medication distribution Time by 85% using Omnicell systems
- Peninsula Regional Medical Center reported less training time and reduced impact of interruptions using AcuDose systems
Pharmacy Automation Jobs
Because this is where I got my start in Healthcare IT, I do have a special appreciation for this career choice. If you are looking to get started in Healthcare IT, have basic technology skills, and are willing to travel, you have a decent chance of getting a job as an Implementation Consultant or Field Engineer. Having some Microsoft or Network+ certification helps, as well as having a pharmacy tech background. If you have programming and/or HL7 experience, then you would have a good chance at a developer position.