Manuel Reyes, a technician with Swisslog, monitors the company's Pill Picker, part of a system of robots located at the Robotic Pharmacy at UCSF Mission Bay. The robots distribute medication to patients at UCSF Medical Center. (Susan Merrell/UCSF)
One of the most important things a pharmacist does after five or six years of training is make sure you get the correct number of pills in the correct dosage.
Now, it seems, robots are better at doing that than people. Even trained pharmacist people. Actually, it's a perfect job for a robot: a repetitive and mundane task.
And artificial intelligence has finally matured to the point where doctors trust robots (with human supervision) to do it. For five years now, the UCSF Medical Center has relied on an automated “robot pharmacy” to fill prescriptions, and a fleet of thousands of autonomous bots to deliver them.
Rita Jew, director of the UCSF program, says the robots have worked for five years with 100% accuracy.
Humans are involved only to stock the medications in the canisters that the robots pluck off a rack, and to grab the packaged and labeled medications the robot spits out and send it on its way.
And if the meds are going to a patient in the hospital, a human might hand them off to a Tug robot that rolls around the hospital from floor to floor, dropping off prescriptions at each nurse’s station.
The job of finding medications and dispensing the right amount for the right patient, is called “pulling” drugs. There used to be seven pharmacy technicians pulling drugs, with three to four pharmacists supervising them. Now, Jew says she needs at most two technicians to interface with the bots, and the other techs were reassigned to work such as collecting medication history
Robots are faster and more accurate than people—a recent study from a medical center in Houston found that in one year their pharmacists made an average of almost five medication errors for every 100,000 prescriptions. That’s not a lot, but it’s a lot more than zero.
Will Robots Replace Pharmacists?
This bionic competition has some pharmacists worried about whether humans have a role in the future of their profession. A paper published in the American Journal of Pharmacy Education last year warned of a potential glut of more than 40,000 pharmacy school grads by 2022.
“Technology and automation are going to do a whole lot of things that the traditional pharmacist has done,” says Dr. Marilyn Stebbins, a pharmacy professor and vice-chair of clinical innovation at UCSF. “If the pharmacists don’t prove their value outside of their existing roles, automation will win because ultimately it will be cheaper.”
That means pharmacists need to carve out new niches robots can’t fill.
California lawmakers recently authorized pharmacists who have certain levels of training and experience to prescribe medications, including nicotine replacements and hormonal birth control, and take a more active role in primary care.
This means the person behind the counter at Walgreens would be able to help patients quit smoking, or review their full medical record to make sure they’re getting the best medication for their condition.
“It’s kind of a pivot in the role of the pharmacist but it’s up to us to take this opportunity,” says Dr. Lisa Kroon, a clinical pharmacy professor at UCSF.
But so far this new role doesn’t come with any extra pay for extra services. The new law doesn’t include regulations to allow pharmacists to be paid for their services. Pharmacists are still reimbursed just for the products they provide. So Stebbins says pharmacists' potential to fill gaps in the healthcare system may remain untapped until there's some way to pay them for it.
Facing a New Future
Kroon has been practicing for 20 years, and she says pharmacists have been talking about the “threat” of automation for as long as she can remember. But she says this is the wrong way to think about technology.
“Our stand here at our school is if [dispensing medication] is all you want to do, don’t come to this school,” Kroon says.
One innovation Stebbins is working on is an app that allows patients to track their blood pressure and other vital signs.
The data are then shared with both their doctor and pharmacist—but it’s the pharmacist who would be responsible for checking in with patients, tracking their data, making sure they’re taking their medication and monitoring whether the medication is working.
“The pharmacist is the ultimate medication manager,” Stebbins says. “That’s what our training is all about.”
Stebbins has also helped develop a new automated call service, in which patients get a phone call within the first two days after they leave the hospital, asking if they have questions about their medication. If they do, Stebbins gets a text or email and she or one of her team of pharmacy students can respond to the patient’s concerns.
Getting the pharmacist involved sooner through services like this call service, frees up more time for the physician to focus on other aspects of the patient’s recovery.
“People have to embrace technology, and not fear it,” she says. “The ultimate thing is that automation has led to the ability for us to reinvent ourselves as a profession, and we need to take the challenge.”