Physician leaders wave red flag on automated pharmacy technology

As retail pharmacy chains rely on automated technology to fill prescriptions, a group of physician leaders is waving a red flag, stating that this technology has serious consequences for patient safety and the future of pharmacy.

Becker's spoke to former pharmacist and current physician Matthew Sewell, MD, PharmD, and physician Purvi S. Parikh, MD, about what they call the dangers of automated technology. Dr. Sewell and Dr. Parikh are both members of Physicians for Patient Protection, a nonprofit, patient advocacy group, and Dr. Parikh sits on its board. The group has more than 12,000 members who advocate for patient safety, physician-led care and truth and transparency in the industry. 

Walgreens recently announced it has begun using robots to fill patient prescriptions. In centralized automated facilities, bright yellow robotic arms whizz away putting thousands of pills into packets for customers. Each robot can fill 300 prescriptions an hour. To fill the same amount of prescriptions would take Walgreens pharmacy staff a whole day. By 2025, half of all customer prescriptions may be filled by such robots. CVS also uses robots to fill prescriptions in its highest volume stores. 

Walgreens CEO Roz Brewer told CNBC that by using automated prescription-filling robots, the company aims to increase the amount of time pharmacists spend providing healthcare. "We're doing all of this work, so that the pharmacist has an easier job, so that they can get back to being front and center, building a relationship with that patient and interacting the way they were trained."

Dr. Sewell begs the question, "What is the end goal of Walgreens or CVS or whoever is using [the technology] and how does that play into patient care and patient safety?" While chain pharmacies have answered the first part of his question, the second goes unanswered and has rung alarm bells for the Physicians for Patient Protection.

Walgreens' stated end goal of shifting pharmacists' time to more patient-centered tasks has both Dr. Sewell and Dr. Parikh worried about patient safety. According to CNBC, Walgreens is urging lawmakers to allow pharmacists to provide a longer list of medical services and wants to turn pharmacists into "hands-on medical care providers."

"My concern is that we've seen pharmacists are overwhelmed, overworked at higher volumes, and there's a lot of burnout happening in the pharmacy field," said Dr. Sewell. "What it appears from the recent article that Walgreens wants to do is allow pharmacists to ideally get provider status and then start making diagnoses and acting more like what physicians should be doing."

Both Dr. Sewell and Dr. Parikh argue that pharmacists are trained specifically in drugs and medications, not in treating and diagnosing patients. Given that the robots are designed to free up pharmacists' time to provide healthcare to patients, both physicians are concerned about how qualified pharmacists are to do so. 

"If they're already overworked, overstressed and doing three to four jobs at once, and then you're now having them in a role that they weren't even trained for, didn't even go to school or a residency or fellowships and have subspecialty training for, that that opens up even more potential errors to occur to the patient as well," Dr. Parikh told Becker's.

In a statement to Becker's Walgreens said that pharmacists have enough training to aid in patient care. "Pharmacists play a critical role as part of patients’ overall care team and have the education, training and expertise to help improve patient care. We believe that enabling our pharmacy professionals to focus on the patient-centered activities for which they are trained and licensed improves patient outcomes, focuses pharmacists on their purpose-driven work with patients, and supports their career satisfaction and advancement." 

CVS also told Becker's that the list of pharmacist responsibilities includes answering questions and advising patients on introducing new medications into their routine, managing multiple medications, mitigating potential drug interactions with other prescriptions, supplements and over the counter remedies. With these responsibilities, their spokesperson said "we’re focused on enabling and empowering our pharmacists to perform at the top of their license."

Physicians for Patient Protection is also concerned with who will be double-checking the efficacy of the robots and how qualified they will have to be. Errors can be made with electronic pharmaceutical dispensers, and it is essential that well-trained individuals are operating and checking the machinery.

"Someone still needs to be verifying what the robot is doing and that needs to be someone that's trained appropriately with higher education, like a pharmacist in medications and medication interactions, and not a pharmacy technician that doesn't have to have a bachelor's degree," said Dr. Sewell. "Will a pharmacist still be the one verifying that what's being dispensed is appropriate and doesn't have any drug drug interactions?" 

A spokesperson from CVS Pharmacy told Becker's that "all prescriptions prepared with the assistance of automation technology are verified and checked by a pharmacist prior to dispensing to a patient, just like any other prescription we fill." 

Walgreens has said it will continue to use pharmacists to fill time-sensitive medications and controlled substances at local stores. It also said that at its micro-fulfilment centers, which use AI to fill thousands of prescriptions, that "multiple, redundant safety and security measures in place to ensure the correct medication is dispensed accurately and safely, all of which is monitored, reviewed and approved by on-site pharmacists, with sites licensed by state boards of pharmacy."

Neither physician is opposed to automated technology itself, especially when it can enhance and streamline workflows and create time for pharmacists and pharmacy technicians. Dr. Parikh argues that in this case robots aren't being used to make work more efficient for pharmacists but instead to bump up their workload.

"They're not planning to use the robot to help an already overworked profession, but instead it's  adding more on their plate, and that more is something that they didn't even train to do or sign up to do," she said.

Ultimately, Dr. Sewell says that these pharmacy chains are implementing this technology to increase their bottom line instead of prioritizing patient safety and employee qualifications. 

"CVS, Walgreens are pushing for pharmacists to have more and more responsibilities that benefit the bottom line of that change drugstore, but it's not benefiting patients because it's creating issues with safety," he said. 

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