Implementing
Automation and
Technology Systems
When Its Good, Its Very, Very Good,
And When Its Bad…
Marian Daum
Christopher Lambert
Roosevelt Gillespie
Pharmacy Informatics
Workgroup
1
OJBECTIVES
• Evaluating your needs:
• Choosing the right equipment for your
operation
• Other factors to consider – Maximum Output
– Minimum Requirements
– Reliability
– Service Contracts
Pharmacy Informatics
Workgroup
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OJBECTIVES
• Pre-implementation – who needs to be
at the table
– Within your department
– Within your facility
– Within your medical center
– Are your timelines realistic
– Are there any other issues?
– What does a good installation look like?
Pharmacy Informatics
Workgroup
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OBJECTIVES
• Doesn’t the machine do the work for
you?
• Setting up a Training Program
• Assessing Competence
• Common Training Pitfalls
Pharmacy Informatics
Workgroup
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OBJECTIVES
Can the system generate the reports you
need?
Do you have the right medication in the
machine?
Are your par levels set too high or too
low?
What else is the system telling you?
Pharmacy Informatics
Workgroup
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Automating a Process
Choosing the Right Equipment
for your Program
Why can’t I get a replicator and a
transporter unit ????
Marian Daum
Pharmacy Informatics
Workgroup
6
AUTOMATING A PROCESS
• What to you want to get out of
automating your process?
• Lower inventory, better turn around
time
• The same amount of medication stored
using less space
• Tight control of a process with
accountability at each step
Pharmacy Informatics
Workgroup
AUTOMATING A PROCESS
MANUAL PROCUREMENT PROCESS
Pharmacy Informatics
Workgroup
AUTOMATING A PROCESS
• What are your options?
– McKesson MedCarousel
– SwissLog Box Picker
– Omnicell WorkflowRx
– Talyst AutoCarousel
– Automed FastFind
Pharmacy Informatics
Workgroup
AUTOMATING A PROCESS
EQUIPMENT
CONTROL
MANAGEMENT
SPACE
TOTAL
McKesson MedCarousel
2
2
3
7 (13)
Swisslog Box Picker
3
2
3
8 (17)
Omnicell WorkFlow Rx
1
2
2
5 (8)
Talyst AutoCarousel
1
2
2
5 (8)
Automed FastFind
3
3
2
8 (17)
Pharmacy Informatics
Workgroup
AUTOMATING A PROCESS
EQUIPMENT
INTEGRATE RELIABLE
SERVICE
CONTRACT
INTERFACE
TOTAL
McKesson Med
Carousel
2
3
3
2
10 (12)
Swisslog Box
Picker
2
3
2
3
10 (12)
Omnicell Workflow
Rx
4
4
3
3
14 (18)
Talyst AutoCarousel 2
3
2
2
9 (11)
Automed FastFind
4
4
2
13 (16)
3
Pharmacy Informatics
Workgroup
AUTOMATING A PROCESS
EQUIPMENT
OBJECTIVES
OTHER
FEATURES
GRAND
TOTAL
McKesson Med Carousel
13
12
25
17
12
29
Omnicell WorkFlow Rx
8
18
26
Talyst AutoCarousel
8
11
19
Automed FastFind
17
16
33
Swisslog Box Picker
Pharmacy Informatics
Workgroup
CHANGING EXISTING
AUTOMATION
Why do you want to change your process?
Process time starts out okay in the morning,
but have a processing time of over an hour
by 2PM.
Problem prescriptions go into an exception file
and you find this out when the patient comes
up to the pickup window to complain.
Pharmacy Informatics
Workgroup
CHANGING EXISTING
AUTOMATION
• Is it reliable?
• Do you get adequate support from the
vendor’s help desk?
• Is there newer, more efficient
technology out there?
Pharmacy Informatics
Workgroup
CHANGING EXISTING
AUTOMATION
Is this machine still able to handle your current
workload?
- Look at hourly processing time in VistA Bingo
Board Manager Program
- Is your staff waiting for the machine to finish
processing prescriptions?
- Is there work that you can shift to another
time?
Pharmacy Informatics
Workgroup
CHANGING EXISTING
AUTOMATION
• Upgrade vs. Replacement
– Cheaper and Less Disruptive
• Newer Version or Higher Capacity
Version of Same Vendor’s Equipment
– Same interface, staff familiarity, disruptive
• Change to another vendor’s equipment
– Most disruptive, staff retraining, patient
inconvenience
Pharmacy Informatics
Workgroup
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Changing Existing
Automation
• Why are you making the change?
– Table of requirements and desires ranked
from most to least important
• Map out the process. What are the
holes in your system?
Pharmacy Informatics
Workgroup
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Changing Existing
Automation
Biggest requirement
- Prescription filling capacity during
peak hours of operation.
ScriptPro SP200 is the existing
equipment
- Upgrade with RCM model
Pharmacy Informatics
Workgroup
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Implementation &
Installation: Avoiding the
Pitfalls
Christopher Lambert
Pharmacy Informatics
Workgroup
19
You Bought It: NOW WHAT?
How to Build an Implementation Team
• Identify the Pharmacy Project Manager
• Identify the Departments Involved /
Departments Impacted
• Identify Responsible / Key Staff within
Each Department
• Schedule Implementation Meetings
• Distribute the Timeline
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Workgroup
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Identify the Pharmacy Project
Manager (That’s you, sucker)
That’s you sucker
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Workgroup
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Identifying the Departments Involved
• Manufacturer Implementation Manager
• Information Resource Management (IRM)
– Data Drops / Telephone Lines / Server
Housing
• Information Security Officer (ISO)
– If equipment is on the VA network
• Engineering / Interior Design / Biomed
– Prepare space for equipment
– Infrastructure upgrades (electricity –
compressed air)
Pharmacy Informatics
Workgroup
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Identifying Impacted Departments
• Nursing
• Procedure Changes
• Medication Packaging Changes
• Pharmacy Staff
• Assignment/Responsibility Changes
Pharmacy Informatics
Workgroup
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Identify Responsible / Key
Staff within Each Department
Request that each involved
department assign a staff
member and a back-up
contact for the project.
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Workgroup
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Implementation Meetings
Good Communication is Key to a
Successful Project
• All involved departments and
Manufacturer Implementation manager
• Clarify each departments responsibility
• Review Manufacturer Timeline
• Schedule follow-up meetings
• Keep and distribute minutes
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Workgroup
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Timeline-Delegate but Verify
-Each assignment is assigned to a
specific Implementation Team Member.
-Completed assignments Verified by
Pharmacy Project Manager.
-Verify Manufacturer is staying on
schedule
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Workgroup
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Pharmacy Implementation
Preparation
• How will the work get done during
Implementation?
• Plan contingencies
• Schedule for off peak periods
• Limit annual leave
• Prepare for implementation to take
much longer than planned
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Workgroup
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What Can Go Wrong:
Don’t Let this Happen to You
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Workgroup
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Automation Training
and Competency
Does anybody know how to work this
thing????
Roosevelt Gillespie
Pharmacy Informatics
Workgroup
2
9
Fallacy: Automation
equipment does the work
Truth is real live human beings do the
work, and the automation equipment is
just a tool they use to do the work,
either:
Faster
In greater volume
More accurately etc.
Pharmacy Informatics
Workgroup
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Typical enthusiasm storyline
•
•
•
•
•
•
Vendor states equipment can fix all problems = High enthusiasm
Getting $$ appropriated to buy gizmo = Less enthusiasm
Coordinating delivery and installation = Significant dent in enthusiasm
Fixing and solving all interface issues, populating databases,
assigning privileges = BIG drain in enthusiasm
Discovery that the installed equipment didn’t solve all problems as
promised = Last drops of enthusiasm drained
Desire to train staff on equipment use = ENTHUSIASM TANK EMPTY 
DON’T FORGET TO TAKE A BREATH, REGAIN YOUR
COMPOSURE AND FUEL
UP FOR TRAINING!
Pharmacy Informatics
Workgroup
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Staff Training: The PenUltimate installation step
Frequently used and high value pieces
of equipment all have the same thing in
common:
• Competent staff who really know how
to use the equipment
• Confident staff who know what they are
doing with the equipment
Pharmacy Informatics
Workgroup
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The most effective staff have
often been….
• Trained by the vendor at the time of
installation at least once 
• Trained yet again shortly after by the
local super user (someone they know
and trust)
• Trained yet again by themselves where
they can “tinker” answer their own
questions by trial and error in private
Pharmacy Informatics
Workgroup
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The worst training possible
Whatever staff in attendance that Friday are
gathered during lunch break for an un-announced
training session on new equipment. The installer
runs through the equipment use, point to an
operating manual and a CD that also contains the
manual. The 1-800 number on the machine is
referenced. The installer smiles at the group, asks if
there are any questions on what they just
demonstrated and when there are no questions has
the group sign the training sheet……….
Pharmacy Informatics
Workgroup
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Better training
•
•
•
•
•
•
•
All staff (including nights/weekends/part time) are included
Training time is after breakfast, but well before lunch
Groups for training are smaller and more intimate when possible
Extra staff coverage is provided during trainings sessions, so staff do
not feel they are falling behind with their regular work
Staff know what equipment is, what it does and have questions
prepared in advance
HANDS ON, HANDS ON, HANDS ON!! Staff should be using
equipment during training, and each member should repeat the same
training, not just one brave volunteer.
Vendor trainer is available after training sessions are complete for
one-on-one questions and mini demonstration during the rest of the
day
Pharmacy Informatics
Workgroup
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Installer is gone. Now What?
• Somebody at your site needs to be a designated
Super User. It can be ANYBODY and you would be
surprised at who that might be. Consider
EVERYBODY in your staff as a potential super-user
• For physical use of the machine, vendor provided
video can be a very good reference
• For equipment with a computer interface, strongly
consider SCREEN SHOTS of the interface as an aid
for navigation through screens and menus.
Pharmacy Informatics
Workgroup
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Prove your good training with a
competency assessment form!
When boiled down, most assessments are the same
• Employee can start up and shut down the equipment
• Employee can calibrate/prepare the equipment
• Employee can load and replace “consumables” in
the equipment
• Employee can demonstrate use of the equipment
• Employee can clean and maintain the equipment
• Employee knows both local support and technical
support contacts in the event of a malfunction.
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Simple is better
Remember the following points about competency
assessment forms and documentation:
• Most regulatory/internal reviews focus on “missing”
competency assessments - not their content. Make them
simple and executable.
• Manufacturer provided “competency” forms have gotten much
better (though many stink ). Don’t overlook them as a source
(vs. making your own from scratch.)
• Keep the competency assessment separate from Policy and
Procedures. Competency assessment shows staff can operate
the equipment, and that is it.
Pharmacy Informatics
Workgroup
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Avoid the following at all costs,
or your equipment will surely DIE
• Nobody knows what equipment is going in, or why they are
getting it, or what it is supposed to do when they get it.
• Everyone is scared of the equipment due to cost, or damage
risk, or complexity.
• Only one person in the pharmacy knows how to run the
equipment and there is no staff rotation through the
equipment.
• There is no reference material or “how to use” sheets
available for individuals to look at.
• Harsh or punitive measures when the equipment breaks or
an “accident” happens (well, at least the first time )
Pharmacy Informatics
Workgroup
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Maximizing Use
• Using Reports to Increase
Efficiency
• Its all in the report…
Marian Daum
Pharmacy Informatics
Workgroup
40
Maximizing Use
• Automation will expose any weakness
in your processes
• Gaps in the database
– Stock out/stock not moving
• Too many manual processes
– Not looking at usage data
• Operator Error
– Don’t forget to push the green button….
Pharmacy Informatics
Workgroup
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Maximizing Use
• Reviewing the Use of Narcotics
• A Surveillance Program
– Discrepancies
Poor Practice vs. Diversion
Involve key staff
Pharmacy Informatics
Workgroup
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Maximizing Use
• Misadventures in Narcotic Use
– You found What above the false ceiling?
– 15 minutes of fame that you can do
without
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Workgroup
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Maximizing Use
• Other Narcotic Surveillance Reports
– Usage Compared to Other Personnel
– Witness Pairs
– Number of Discrepancies
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Workgroup
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Maximizing Use
• What about that installation?
– What did you get out of the change in
process?
• Better Inventory Management
• Better Turn Around Time
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Workgroup
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Maximizing Use
• Unexpected Benefits
– The law of unintended consequences can
sometimes be a good thing.
– Are you able to demonstrate additional benefits to
your recent upgrade?
Pharmacy Informatics
Workgroup
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Maximizing Use
• What if I want to kick it up a notch?
• Advanced Report Writing
• Custom Reports
• Combining VistA and the automation reports
Pharmacy Informatics
Workgroup
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Maximizing Use
• Please share with the entire class
• http://vaww.national.cmop.va.gov/pre/default2/default.aspx
• Please post your best practices on the
automation Sharepoint discussion
board
Pharmacy Informatics
Workgroup
48
Automation
• Choosing the best equipment for your
service
• Developing an implementation plan for
a smooth installation
• Developing a comprehensive training
and competency assessment program
• Evaluating the performance of the
equipment on an on-gong basis
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Questions??
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