Walgreens Turns to Prescription-Filling Robots to Free Up Pharmacists(wsj.com)
wsj.com
Walgreens Turns to Prescription-Filling Robots to Free Up Pharmacists
https://www.wsj.com/articles/walgreens-turns-to-prescription-filling-robots-to-free-up-pharmacists-11664713243
92 comments
Where I live, pharmacists can rewrite prescriptions from doctors, write their own (in limited cases) and in some circumstances extend prescriptions without renewals from a doctor (e.g. a family member was still able to get bipolar medication even though on paper they shouldn't have). Pharmacists are given the power and responsibility to fix mistakes, their specialty is the exceptional cases that computers aren't coded for, that's why they are highly educated and paid.
How can a person possibly be better at knowing the graph of drug interactions better than a program can?
Like, isn't the human just going to have human error (like the doctor)?
Like, isn't the human just going to have human error (like the doctor)?
That's so simple it's coded into all prescribing systems and even written in paper prescribing manuals. The issue is that while some interactions are harmful, many are harmless and some even beneficial, but knowing the context that influences this range of effects is based on more than the contents of the prescription. Judgement and wider knowledge of the patient is required. People are still good at that but not infallible. I'm an ex pharmacist. Drug interactions, overdoses and plain wrong drug mistakes abound even in the age of computerised prescribing.
One of my bosses has a photo of her and a child's prescription fixed to the wall of a paediatric consultant who would have a killed a child if a pharmacist, my boss, had not queried a prescription.
Checking each other's work is essential in many industries but more so in healthcare.
One of my bosses has a photo of her and a child's prescription fixed to the wall of a paediatric consultant who would have a killed a child if a pharmacist, my boss, had not queried a prescription.
Checking each other's work is essential in many industries but more so in healthcare.
The difference being that two different people are unlikely to have the same error.
Whereas the software will gladly just make the same mistake over and over again until corrected.
The dictation on my phone is pretty good. It's still frequently wrong.
Whereas the software will gladly just make the same mistake over and over again until corrected.
The dictation on my phone is pretty good. It's still frequently wrong.
There are pretty good databases of known harmful drug interactions available from vendors like Wolters Kluwer. Those are generally already integrated with the eRx features of most modern EHRs and pharmacy systems, and will pop up an alert.
The problem is that patient charts are often incomplete, or lacking proper RxNorm or NDC codes for the current medication list. So competent clinicians have to prevent problems from slipping through the cracks using their judgment and intuition. This is not something which can ever be automated (short of a true AGI).
The problem is that patient charts are often incomplete, or lacking proper RxNorm or NDC codes for the current medication list. So competent clinicians have to prevent problems from slipping through the cracks using their judgment and intuition. This is not something which can ever be automated (short of a true AGI).
> The problem is that patient charts are often incomplete, or lacking proper RxNorm or NDC codes for the current medication list.
The first seems like a problem - but not something a top 5% wage earner needs to do. The second can be handled by machines just fine.
The first seems like a problem - but not something a top 5% wage earner needs to do. The second can be handled by machines just fine.
Wrong. It can't be reliably handled by machines. If you can figure out how to do it then you can make a fortune.
Addressing gaps and errors in a patient chart is a highly complex task. Low skilled workers don't even know what to look for, or what questions to ask. A lot of this is tacit knowledge which we don't know how to reduce to software.
Addressing gaps and errors in a patient chart is a highly complex task. Low skilled workers don't even know what to look for, or what questions to ask. A lot of this is tacit knowledge which we don't know how to reduce to software.
"Driverless cars are easy, just follow the rules of the road!"
Lord, please grant me the confidence of this HN poster.
https://en.m.wikipedia.org/wiki/Therac-25
Humans aren’t perfect, but computer programs are only as good as the programming.
Humans aren’t perfect, but computer programs are only as good as the programming.
Humans are more than capable of writing programs that exceeds the most elite humans in the world, such as in go or chess. In nature we find creations exceeding creators all the time, so we shouldn't really be too surprised.
They are also capable of releasing bad software to production.
go and chess are infinitely simpler than drugs, humans and their interactions.
it's like saying autonomous driving is easy you just have to follow the road and read the signs, we have the best minds and unlimited money working on it for a decade+ and it still suck ass
it's like saying autonomous driving is easy you just have to follow the road and read the signs, we have the best minds and unlimited money working on it for a decade+ and it still suck ass
> How can a person possibly be better at knowing the graph of drug interactions better than a program can
Than it should warn the human doctor before he write the script.
Than it should warn the human doctor before he write the script.
As I mentioned in another comment, this has already been happening for 10+ years. The eRx modules in all certified EHRs do automatically check for potentially harmful drug interactions.
https://www.healthit.gov/test-method/drug-drug-drug-allergy-...
The problem is that the patient's chart may be erroneous or incomplete. So the system can only detect harmful interactions on entries that are fully populated with RxNorm (or NDC) concept codes. Human doctors are expected to manually reconcile the medication list before writing a new prescription. But sometimes they skip that step, or patients don't even remember what other drugs they're taking. In some cases it's possible to query the patient's current medication list from a service like Surescripts but even that won't necessarily be complete and some level of manual reconciliation is still needed.
The other issue with drug interaction warnings is alert fatigue. For certain drugs there are a lot of known interactions, but those are considered minor acceptable risks due to lack of a better alternative. So clinicians get into a habit of ignoring all warnings and miss the ones that are actually serious. From a UX perspective there's no good way to solve this problem in a way that satisfies both the clinicians and the lawyers.
https://www.healthit.gov/test-method/drug-drug-drug-allergy-...
The problem is that the patient's chart may be erroneous or incomplete. So the system can only detect harmful interactions on entries that are fully populated with RxNorm (or NDC) concept codes. Human doctors are expected to manually reconcile the medication list before writing a new prescription. But sometimes they skip that step, or patients don't even remember what other drugs they're taking. In some cases it's possible to query the patient's current medication list from a service like Surescripts but even that won't necessarily be complete and some level of manual reconciliation is still needed.
The other issue with drug interaction warnings is alert fatigue. For certain drugs there are a lot of known interactions, but those are considered minor acceptable risks due to lack of a better alternative. So clinicians get into a habit of ignoring all warnings and miss the ones that are actually serious. From a UX perspective there's no good way to solve this problem in a way that satisfies both the clinicians and the lawyers.
Alert fatigue is real and sets in quickly -
Who's writing the software ? Humans
1 human error in the software = millions of people affected
1 human error by a pharmacist = 1 person impacted
1 human error in the software = millions of people affected
1 human error by a pharmacist = 1 person impacted
And yet, who's writing calculator software?
Beside overflows, it doesn't error.
And yet, who's writing chess software?
And yet - there's no human in the world that can ever beat a chess program.
And yet, who's writing Google?
And yet - there's no human in the world that can recommend webpages like Google.
The list goes on.
Humans are bad at memorizing a GIGANTIC lists and not making mistakes.
Humans are EXCELLENT where error is okay and it's not really clear what the goals are.
I don't really know anything about pharmacy - but it does not appear to fall into category 2.
Beside overflows, it doesn't error.
And yet, who's writing chess software?
And yet - there's no human in the world that can ever beat a chess program.
And yet, who's writing Google?
And yet - there's no human in the world that can recommend webpages like Google.
The list goes on.
Humans are bad at memorizing a GIGANTIC lists and not making mistakes.
Humans are EXCELLENT where error is okay and it's not really clear what the goals are.
I don't really know anything about pharmacy - but it does not appear to fall into category 2.
> And yet, who's writing calculator software?
Push calculators far enough and they'll all give you different results
We're talking potential human life here.
If you don't see the difference between a dumb game like chess and the infinitely complex world of medication and facing patients I honestly don't know what to tell you. Every customer facing people we replaced by computers degraded the experience for the customers
Push calculators far enough and they'll all give you different results
We're talking potential human life here.
If you don't see the difference between a dumb game like chess and the infinitely complex world of medication and facing patients I honestly don't know what to tell you. Every customer facing people we replaced by computers degraded the experience for the customers
Two humans looking at something are better than one.
But a program could still have a much lower error rate.
Humans tell the program how to act, it's chicken and egg.
No, it's not.
Humans tell a calculator how to calculate.
It's never wrong. Humans (without a calculator) get math wrong constantly.
Humans tell a calculator how to calculate.
It's never wrong. Humans (without a calculator) get math wrong constantly.
The pharmacists still have to consult per existing law. The robots would not hand the prescriptions directly to the patient.
Right now large chain pharmacists basically have to talk and fill at the same time to keep up. That’s not good for patients either.
Right now large chain pharmacists basically have to talk and fill at the same time to keep up. That’s not good for patients either.
How many people use compounding pharmacies outside of hospitals nowadays? I'm personally happy to see the possible automation of low-level work in the pharmacy world.
I honestly never quite understood why prescriptions in the US need to be literally filled, when in the EU, for example, you can just walk up with your prescription to any pharmacy and buy a prepackaged blister pack of the medicine you need.
Not only do blister packs save so much waiting time — you never have to wait for it unless it's out of stock — but it also feels like there's less chance for anything to go wrong when manually handled by the pharmacist, factoring cross-contamination or incorrect filling, even though the pharmacists would either way be liable for it.
Blister packs are verifiably sealed by the manufacturer, you're more likely to tell if they've been tampered with, you don't have to worry about moisture seeping into the excipient and interacting with the active ingredients, and they provide a visual representation of how many pills you have already taken, without needing to count pills in a bottle.
Not only do blister packs save so much waiting time — you never have to wait for it unless it's out of stock — but it also feels like there's less chance for anything to go wrong when manually handled by the pharmacist, factoring cross-contamination or incorrect filling, even though the pharmacists would either way be liable for it.
Blister packs are verifiably sealed by the manufacturer, you're more likely to tell if they've been tampered with, you don't have to worry about moisture seeping into the excipient and interacting with the active ingredients, and they provide a visual representation of how many pills you have already taken, without needing to count pills in a bottle.
It's mostly just how it's been done. You can still get a prescription "filled" by getting blister packs in the US.
But if you think of drugs that are dispenses in the tens of thousands each month, like cholesterol medication - the amount of packaging the pharmacy would have to store would be massive.
But if you think of drugs that are dispenses in the tens of thousands each month, like cholesterol medication - the amount of packaging the pharmacy would have to store would be massive.
It's more than tradition and efficiency; the US doesn't have the supply chain trust issues that many other countries do when it comes to prescription drugs. There are plenty of parts of the world where a bottle of loose pills is going to be treated as suspect no matter who dispenses it to the patient.
Giving consumers individual packages with counterfeit-deterrent measures and serialization that can be verified with the manufacturer as part of a valid production lot increases consumer confidence and makes counterfeiting more difficult.
Giving consumers individual packages with counterfeit-deterrent measures and serialization that can be verified with the manufacturer as part of a valid production lot increases consumer confidence and makes counterfeiting more difficult.
Healthcare executive 20 years, wrote Hacking Healthcare for O'Reilly... So long as this is used for routine filling of routine medications with low risks I think this can work. However it is also my opinion that Walgreens is a very, very poorly run organization. If you followed the Theranos story and documents you can see just how poorly.
To the people saying pharmacists should not be involved at all, that is insane. Prescription errors are a very large source of preventable error that causes significant harm. Lots of error cannot be solved by computer because it lacks the information, like identity, drug and dosing errors. There are a lot of inputs that only a human can evaluate at dispensing time. This robotic filling, as I read it, does not necessarily prevent that.
For reference, there are roughly ~110 million possible drug formulations (drug x dose x route etc) that are currently legally dispensable and distinct, in the US. Any drug can interact with any other, different dose x route x drug combinations may interact differently. A large set of the population is on dozens of drugs simultaneously. Taking into account the patients age/weight/race/level of sickness is important and makes the overall matrix very very large for raw computation.
You might then say: well humans aren't good at a matrix that large either, that is in some ways true but humans are pretty good at detecting exceptional circumstances even though though they are not rotely walking that large key space. It is also true that there is a heavy weighting towards about 1,000 much more common drugs. It is not a new idea to add computers to interactions/dispensing/etc. It has been tried for 20 years, the outcome results of many efforts have been poor.
A gold standard in pharmacy interactions is to maximize the amount of time between pharmacist and patient. Pharmacists aren't pill monkeys rotely stuffing things in bottles. They have important diagnostic, education and safety functions. Especially when they can see and interact with the patient. If there was any true broad economic incentive to be preventative pharmacists would take your vitals and temperature as well but currently our system does not make that economic.
To the people saying pharmacists should not be involved at all, that is insane. Prescription errors are a very large source of preventable error that causes significant harm. Lots of error cannot be solved by computer because it lacks the information, like identity, drug and dosing errors. There are a lot of inputs that only a human can evaluate at dispensing time. This robotic filling, as I read it, does not necessarily prevent that.
For reference, there are roughly ~110 million possible drug formulations (drug x dose x route etc) that are currently legally dispensable and distinct, in the US. Any drug can interact with any other, different dose x route x drug combinations may interact differently. A large set of the population is on dozens of drugs simultaneously. Taking into account the patients age/weight/race/level of sickness is important and makes the overall matrix very very large for raw computation.
You might then say: well humans aren't good at a matrix that large either, that is in some ways true but humans are pretty good at detecting exceptional circumstances even though though they are not rotely walking that large key space. It is also true that there is a heavy weighting towards about 1,000 much more common drugs. It is not a new idea to add computers to interactions/dispensing/etc. It has been tried for 20 years, the outcome results of many efforts have been poor.
A gold standard in pharmacy interactions is to maximize the amount of time between pharmacist and patient. Pharmacists aren't pill monkeys rotely stuffing things in bottles. They have important diagnostic, education and safety functions. Especially when they can see and interact with the patient. If there was any true broad economic incentive to be preventative pharmacists would take your vitals and temperature as well but currently our system does not make that economic.
I disagree that it’s as complicated as you’re making it seem. There are only a few cases, relatively, where the “age/weight/race/level of sickness” is taken into account, and the prescribing physician would be the one that makes that call rather than a pharmacist.
There’s also nothing that says that information couldn’t be transferred along with a prescription. It’s not like a centralized system wouldn’t have all that information about you, along with any other prescriptions and even non-prescription medications previously purchased with Walgreen’s (or any other pharmacy, they all do it) rewards card.
A computer can also certainly be trained to identify outliers, and can certainly process complex interactions (not that there’s nearly as many or as varied and diverse as you’re making it seem) better than a human can, with the same data. At the end of the day there’s a finite number of these interactions, and while things like dosage might affect some, overall it’s groups of drugs that interact with each other which is generally looked at.
Finally, at least for me, every time I get a prescription filled I get literally a 5 second conversation with a pharmacist at best. 10 seconds if it’s a new prescription with a particularly bad side effect.
Suffice to say, I don’t think you’ve shown why exactly a human would be better than a machine at this job.
There’s also nothing that says that information couldn’t be transferred along with a prescription. It’s not like a centralized system wouldn’t have all that information about you, along with any other prescriptions and even non-prescription medications previously purchased with Walgreen’s (or any other pharmacy, they all do it) rewards card.
A computer can also certainly be trained to identify outliers, and can certainly process complex interactions (not that there’s nearly as many or as varied and diverse as you’re making it seem) better than a human can, with the same data. At the end of the day there’s a finite number of these interactions, and while things like dosage might affect some, overall it’s groups of drugs that interact with each other which is generally looked at.
Finally, at least for me, every time I get a prescription filled I get literally a 5 second conversation with a pharmacist at best. 10 seconds if it’s a new prescription with a particularly bad side effect.
Suffice to say, I don’t think you’ve shown why exactly a human would be better than a machine at this job.
Maybe 90 percent of medicine dispensing is without issue and you fall into that category. The other 10 percent is where a pharmacist comes in. That being said, I don't need a pharmacist to review my 4 decade long prescription for inhalers.
In a non-compounding pharmacy (which is what most pharmacies are now days) I presume they are not making pills or capsules. So one could eliminate almost all of the chain if pills just came pre-packaged in containers closer to what is given to the consumer. I.e.: put this stuff in small jars at the factory with a machine.
In the rest of the world pharmaceutical drugs come in end-user retail packaging.
Primarily blister-packs.
It’s mostly only the USA that has bulk packaging that is then counted out into bottles at the time of dispensing.
It’s mostly only the USA that has bulk packaging that is then counted out into bottles at the time of dispensing.
This is true, retail pharmacies order bulk packages, however in hospitals we order blister packs since unit dose is preferred.
I never understood why drug manufacturers bother creating retail packaging for their drugs which the patient never sees. It just ends up in that generic orange bottle anyways. Why not cut out the middleman? Package them in common amounts at the factory, and then slap the doctor's instructions on the bottle.
One (common) prescription I get I just get a pre-packaged prescription bottle with a label slapped on. Not sure why my other equally common prescriptions aren't provided in the same form.
Presumably it’s much more cost effective to ship pills in containers that are much larger than increments of 30, 60, 90 etc. But paying a pharm tech to count it isn’t really free.
I wish I knew too, because one of my scripts is like that as well and it’s only a 30 unit script.
I wish I knew too, because one of my scripts is like that as well and it’s only a 30 unit script.
And yet, we don't ship (most) food in bulk to supermarkets for local repackaging for consumer sale. Certainly it's cheaper for the manufacturer to ship in larger lots and have the retailer take care of the consumer sale, but it's usually more efficient overall to do at least most of the packaging at the factory.
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So I had to look up drug packaging and the second sentence on wikipedia says:
Pharmaceutical packaging is highly regulated but with some variation in the details, depending on the country of origin or the region.
https://en.wikipedia.org/wiki/Drug_packaging
Pharmaceutical packaging is highly regulated but with some variation in the details, depending on the country of origin or the region.
https://en.wikipedia.org/wiki/Drug_packaging
We already do this for Zithromax Z-Pak, Imitrex, Diflucan, and Medrol DosePak where the directions and prescribed quantity are always the same.
For other drugs, in practice you get short supply on a drug, and can only fill a partial, or you have patients that only want a weeks worth.
Another factor is the packaging adds extra cost, and it's cheaper to order a bulk 500 count bottle.
For other drugs, in practice you get short supply on a drug, and can only fill a partial, or you have patients that only want a weeks worth.
Another factor is the packaging adds extra cost, and it's cheaper to order a bulk 500 count bottle.
Interesting it took them this long to purse the opportunity here.
Something like 10-20 drugs make up like 80% of the maintenance meds dispensed in the US daily.
Supply chain efficiencies like this were monetized 20+ years ago by most of the major PBMs/health plans (look at their 'mail order dispensing pharmacies' to see them in action).
Doing a regionalized fulfillment play for your high volume geographies will likely save hundreds of millions in opex i'm guessing.
Will be curious to see if WBA can scale as quickly as they want here. I'm sure there are many industry partners who could lend a hand :)
Something like 10-20 drugs make up like 80% of the maintenance meds dispensed in the US daily.
Supply chain efficiencies like this were monetized 20+ years ago by most of the major PBMs/health plans (look at their 'mail order dispensing pharmacies' to see them in action).
Doing a regionalized fulfillment play for your high volume geographies will likely save hundreds of millions in opex i'm guessing.
Will be curious to see if WBA can scale as quickly as they want here. I'm sure there are many industry partners who could lend a hand :)
Indeed, my health plan uses Express Scripts. It's been utterly foolproof.
Presumably this will prevent pharmacists from denying people their prescriptions on religious grounds, which would be a welcome change.
Unfortunately, that's not how it works. The prescription has to be reviewed by a pharmacist before it will even dispense through an automatic dispensing system.
No because the process has to be supervised by a pharmacist.
Indeed, I fail to see why a pharmacist still couldn't refuse to turn on the pill filling machine anyway on religious grounds.
Doesn't "free up" actually, eventually mean "fire"? Reduce employment costs?
Like kiosks at fast-food places?
Personally I'm sticking to mail-order rx for the rest of my life, pretty sure I caught covid at the pharmacy from the pharmacist who was refusing to mask. Imagine how filthy that checkout pad is at the pharmacy with every sick person touching it. Plus the prices are much more competitive.
Like kiosks at fast-food places?
Personally I'm sticking to mail-order rx for the rest of my life, pretty sure I caught covid at the pharmacy from the pharmacist who was refusing to mask. Imagine how filthy that checkout pad is at the pharmacy with every sick person touching it. Plus the prices are much more competitive.
I don't see it as jobs lost, but jobs moved. You still need people to build these robots (or self-service kiosks), and you need people to maintain both hardware and software. One less pharmacist at the front-line is one more developer working on the software, or maybe that pays for two technicians instead. It's no different at the fast food level ether, it's just Industry 4.0 thinking in retail.
In general, costs are a decent estimate of the amount of work needed to do something.
And we know that automation greatly reduces costs.
And we know that automation greatly reduces costs.
Yes, but we really should take a more optimistic view of automation. We now have an autonomous system that can do work a human previously had to waste their time and effort doing.
The automation isn't the problem, it's capitalism. The gains from automation are realized by the owner which isn't the worker.
The automation isn't the problem, it's capitalism. The gains from automation are realized by the owner which isn't the worker.
I’ve automated away plenty of jobs. Even had my own job automated once.
People don’t get fired. Worst case is the company stops hiring, and lets “natural attrition” take over.
Companies spend a lot of money hiring people, and good workers are hard to find.
If you’re happy with an employee, and they would prefer to stay instead of find a new job, then you have a good match. Don’t mess with that.
People don’t get fired. Worst case is the company stops hiring, and lets “natural attrition” take over.
Companies spend a lot of money hiring people, and good workers are hard to find.
If you’re happy with an employee, and they would prefer to stay instead of find a new job, then you have a good match. Don’t mess with that.
What you are saying is true and no-one is foolish enough to think a minimum-wage job is "forever".
But the thing is people think going to college and studying a lot with a big time investment to become a pharmacist is probably a long-term job.
Now a pharmacist is basically a minimum-wage job, they are replaceable on demand by season and profitability.
This doesn't bode well for a society when you rely on someone who then believes their job is disposable.
Then there is that pesky anchor in the USA of health insurance tied to a job.
But the thing is people think going to college and studying a lot with a big time investment to become a pharmacist is probably a long-term job.
Now a pharmacist is basically a minimum-wage job, they are replaceable on demand by season and profitability.
This doesn't bode well for a society when you rely on someone who then believes their job is disposable.
Then there is that pesky anchor in the USA of health insurance tied to a job.
This is interesting to me, as I try to change careers with no degree. I recently applied for the Walgreens Pharmacy Tech Apprenticeship.[^1] But, it seems like those jobs will be automated away soon too... I'm really looking for a tech support job, but options are limited in this small town.
[^1]https://jobs.walgreens.com/en/pharmacy#grid-content-1-2
[^1]https://jobs.walgreens.com/en/pharmacy#grid-content-1-2
Pharmacy Techs should be relatively safe for awhile. In a busy pharmacy the techs do most of the work with a single pharmacist overseeing. Techs even operate the automated pill counters and such.
Archive with full text of article: https://archive.ph/AxyKF
Probably not a popular opinion, but I think we can do away with the vast majority of pharmacist. There are machines that can properly identify, sort, bottle, label, and provide prescriptions with little to no human intervention. All it seems the pharmacist does is pop bottles, fill prescriptions, file insurance claims over and over and over again.
At least in the UK the pharmacist’s job is to check the prescription makes sense and isn’t going to poison the patient, and also to give crucial directions to the patient as they probably won’t read the leaflet. Seems like an important job.
It is the same in the US. The problem currently is the volume retail pharmacists (not hospital pharmacists) are asked to fill - it is harder to have time for interventions.
I think most pharmacists would welcome the chance to count fewer pills and apply their PharmD skills.
I think most pharmacists would welcome the chance to count fewer pills and apply their PharmD skills.
In the UK the vast majority of medications come in blister packs corresponding to a typical dose. So pharmacists are not counting individual pills, only trays. This seems like an obvious thing that the US could adopt.
So pre-record the instructions for taking the medicine in English / Spanish / Mandarin etc, stick ‘em in one of those booths like they have at the porn store and call it a day.
I had a doctor mistakenly up my dosage tenfold when doing a routine renewal. My pharmacist didn’t notice the change and filled it.
Surely an algorithm would have flagged this as suspicious (I’d been on the same dose for years).
Surely an algorithm would have flagged this as suspicious (I’d been on the same dose for years).
Drug contraindications are automatically flagged though. In principle yes they have to do that, but rarely if ever in practice.
Drug contraindication flagging is not something a computer can do effectively. Garbage datasets on drug warnings, garbage data on patient conditions - it truly takes a highly trained human.
Maybe not for filling your 1 script - but for polypharmacy patients it saves lives.
Maybe not for filling your 1 script - but for polypharmacy patients it saves lives.
My wife is a physician—she says that nearly every single drug she prescribes gets flagged by the computer for some kind of contraindication.
What types of contradictions fail in the computer but pass the doc ?
Why does this difference exist?
Why does this difference exist?
Drug interactions are complex, graduated, and probabilistic.
It’s generally not “drug A and drug B combined with definitely kill you” it more of “there’s a small study that shows that people who take drug A while taking drug B have a higher chance of experiencing side effect C”, or “patients taking drug A who have condition D, might experience problem E”.
It’s about managing risk, making judgement calls, and accepting responsibility.
There also just isn’t data for every possible drug combination or patient problem combination out there.
It’s generally not “drug A and drug B combined with definitely kill you” it more of “there’s a small study that shows that people who take drug A while taking drug B have a higher chance of experiencing side effect C”, or “patients taking drug A who have condition D, might experience problem E”.
It’s about managing risk, making judgement calls, and accepting responsibility.
There also just isn’t data for every possible drug combination or patient problem combination out there.
The computers flag many moderate contradictions and allow the human to decide.
Humans can ask questions or have information about the patient that the very rudimentary algorithms don’t.
Humans can ask questions or have information about the patient that the very rudimentary algorithms don’t.
> moderate contradictions and allow the human to decide
It's so much worse than that. The standard for side effects is pretty low and relies mostly on patient reports. So there ends up being a long tail of extremely rare or misattributed side effects.
It's so much worse than that. The standard for side effects is pretty low and relies mostly on patient reports. So there ends up being a long tail of extremely rare or misattributed side effects.
Very true in retail and hospital pharmacy setting as well.
What are you even talking about? Drug data is very normalized. PDB does all of this already.
This is true, however a pharmacist is ultimately responsible (& legally responsible) for deciding actionable events after a discovery -- this is all logged and signed with electronic signature in case of mistakes and lawsuits.
Except in a few very rare cases, we don't really have that in the US. In the US, the job of the pharmacist is mostly to deny patients their prescription medicine on an insurance companies behalf, or to deny a handful of the most vulnerable patients their prescription medicine because of personally-held extremist political beliefs. (/s, but like, only slightly)
Very confidently incorrect. Doctors generally know very little about drugs and dosing - the pharmacist is the one protecting you from mixing inappropriate meds.
How can this be? Every prescription I’ve ever had was dosed by my doctor. How can you possibly prescribe a drug without knowing about drug dosing?
This has been my experience exactly.
I really like how the pharmacist who knows literally nothing about me, my diagnosis, life circumstances, family history etc... is supposed to be "the last line of defense" against all those silly doctors writing prescriptions that will kill their patients. It almost seems like the doctor might be the right person to decide what medications would work for me.
If I didn't know better I might think that pharmacists inflate their importance to try and maintain their comfortable position with a nice salary for a job that a fancy soda machine could do.
I really like how the pharmacist who knows literally nothing about me, my diagnosis, life circumstances, family history etc... is supposed to be "the last line of defense" against all those silly doctors writing prescriptions that will kill their patients. It almost seems like the doctor might be the right person to decide what medications would work for me.
If I didn't know better I might think that pharmacists inflate their importance to try and maintain their comfortable position with a nice salary for a job that a fancy soda machine could do.
If you knew or read about retail pharmacists’ quality of life at work (and pay), you would know they are about as far from comfortable as possible. And their pay dropped precipitously over the 2010 to 2020 years when everyone else’s rise. And they get to work evenings and nights and weekends, and they get to deal with the general public, be on their feet all day, work without other professional colleagues, and work with unreliable minimum wage coworkers who are constantly changing.
See /r/pharmacy or sdnforum.
See /r/pharmacy or sdnforum.
My local pharmacy has a pill dispensing robot for the common prescriptions. This story seems to be more about centralizing the workload to some big locations than it is incidentally about the robots.
It's going to be fun to be on the front line when this new chain borks up and some bignum% of your customers can't pick up their Rx for a few days.
It's going to be fun to be on the front line when this new chain borks up and some bignum% of your customers can't pick up their Rx for a few days.
Once Walgreens proves it works, won't take long for every other pharmacy to follow.
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What a needlessly complex, pointless machine. Reminds me of the brick-laying robot.
Then maybe you should build a simpler robot. There is a huge market in other pharmacies and you could make a fortune.
Or maybe you have no clue about robotics, and don't understand the actual complexities involved.
Or maybe you have no clue about robotics, and don't understand the actual complexities involved.
TCO will be far higher than traditional fills. This won't eliminate any positions, you'll still need people to handle the orders, load the hoppers, etc. You'll have people just standing around (best case) or fighting with the machine half the time (more likely).
In all but the highest volume setting, this is a waste of money. That doesn't describe your neighborhood Walgreens. I'm confident that if you follow the money on this project, a board member of Walgreens owns part of the robotics company or is affiliated with a VC firm that's backing it. There's no way this isn't straight corporate legalized theft.
Feel free to follow up with me in 5 years when everyone's totally forgot about this farce.
In all but the highest volume setting, this is a waste of money. That doesn't describe your neighborhood Walgreens. I'm confident that if you follow the money on this project, a board member of Walgreens owns part of the robotics company or is affiliated with a VC firm that's backing it. There's no way this isn't straight corporate legalized theft.
Feel free to follow up with me in 5 years when everyone's totally forgot about this farce.
Pharmacists usually don't fill prescriptions in the sense of counting out the pills into the bottles. Pharmacy technicians do that. Pharmacists have a lot more training and have to be able to discuss drug interactions and side effects with patients, etc. Article is paywalled but it is technicians, not pharmacists, that they are trying to "free up".
I've been a Walgreens customer since birth, but after multiple incidents of vaccination appointments getting blown off and lost prescriptions and test results I moved all my prescriptions somewhere else earlier this year. They can't keep their pharmacies staffed. Getting prescriptions filled by a robot sounds like it would feel unsafe, but getting prescriptions filled by an overworked skeleton crew felt pretty unsafe too. I hope the robot isn't from the same team that built those awful always-busted screens they have on their drink coolers now that keep you from seeing what is in them.
Pharmacy techs are the ones that fill the scripts, but the pharmacist is ultimately responsible that it's correct.
Pill filling robots are great if you're filling the same 10 scripts, but not very useful when dealing with complex and compounding scripts.
My father was a pharmacist and we owned an independent pharmacy and I remember how often the scripts written by the doctor was so wrong and had it not been caught it would have killed the patient.
Knowledge of drug interactions are key, but these days new pharmacists just look up online, so a pill filling robot could work.