Ballad Health, based in Johnson City, Tenn., is building what some hospitals are only beginning to imagine: a centralized pharmacy powered by automation. At a centralized facility in Bristol, Tenn., robots now handle everything from filling and labeling medications to preparing IV syringes for the operating room. Together, these systems form one of the first hospital pharmacy models in the nation to unite central dispensing and IV compounding robotics under a single roof.
The move, said Trish Tanner, Ballad’s chief pharmacy officer, was born from necessity and vision.
“We were looking ahead to staffing shortages and wanting to overcome those,” she said. “But it was also about bringing a higher level of quality and safety through barcode scanning and automation.”
Unlike many health systems that run central-fill programs, Ballad did not build a warehouse to load totes of medications for hospital staff to restock. Instead, Dr. Tanner said it removed nearly all drug inventory from its hospital pharmacies entirely. The central team now orders, picks, delivers and stocks the automated dispensing cabinets in each hospital, checks expiration dates and even performs unit inspections. Only controlled substances remain on site at hospitals.
Ballad’s operation supports all 20 of its hospitals and about 100 clinics, with dozens more scheduled to join this year. The change, Dr. Tanner said, removes layers of redundancy — and with them, potential for human error. Robots perform each step under barcode verification, and since the system launched, there have been no picking errors.
The early outcomes suggest the model is working. Pharmacist-led clinical interventions have risen 41%, and 94% of STAT medication orders are verified under five minutes. Stockouts have fallen by nearly two-thirds. For Dr. Tanner, those numbers represent more than efficiency metrics; they capture a shift in what pharmacy work looks like.
“It’s not about replacing our staff,” she said. “It’s about redeploying them to higher-level tasks so they can practice at the top of their license. The ultimate goal is to have the pharmacist at the bedside.”
But before automation could take hold, Ballad had to standardize almost everything: its formulary, drug concentrations, crash-cart trays, anesthesia kits, even the override rules in automated dispensing cabinets.
“Standardize, standardize, standardize,” Dr. Tanner said. “It’s been many years in the making to have the infrastructure to pull this off.”
Implementing the new system required as much attention to people as to machines. Dr. Tanner spent months shaping the messaging for pharmacy teams, emphasizing that the project was about improving safety and freeing clinicians for more meaningful work.
“Change is always difficult, even when it benefits us,” she said. “We started with the message of getting the pharmacist to the bedside — and for technicians, working at the top of their license.”
The results have drawn notice from vendors and peers. According to Dr. Tanner, Omnicell executives told her they are not aware of another customer worldwide using both central dispensing and IV-compounding robotics in one integrated operation.
Still, she sees this as a beginning rather than an endpoint. Dr. Tanner sits on the board of Autonomous Pharmacy, a consortium of health system leaders and technology developers exploring what full automation could look like.
“There are technologies that don’t exist today,” she said. “Part of our work is visioning — what are our gaps, what do we need, and how can vendors partner with us to move patient safety and quality further along?”
For Ballad Health, the answer so far lies in a facility in which the pharmacy’s most repetitive tasks are no longer human ones, and where the people behind the machines are finding new ways to practice closer to patients.
