Pill Fill Automation is Good Medicine
CPP Manager William Toy watches as giant pill dispensers fill prescription bottles at the Kaiser Permanente centralized pharmacy. The automated system fills about 35,000 prescriptions a day.
Walking into Kaiser Permanente's centralized prescription pharmacy (CPP) in Livermore is a little like watching toy soldiers come alive at night. Little plastic pill bottles travel purposefully along conveyer belts through the giant warehouse. They stop, fill up with pills, and then it's back on the belt to be scanned, checked by a pharmacist, capped, and sorted, and checked again before being packaged and shipped to members' medicine cabinets.
But it's not make-believe that turns about 40,000 generic plastic pill bottles a day into life-saving remedies. It is a highly automated, multimillion dollar operation that supplies millions of northern California Kaiser Permanente members, from Fresno to Santa Rosa, with their medications. Nearly 40 percent of prescriptions written by physicians in the region are filled in this central pharmacy. The other 60 percent are filled at Kaiser Permanente pharmacies in the service areas.
Started a decade ago, the centralized operation increases efficiency and saves money, said pharmacy services manager William Toy, PharmD. It also reduces crowds at the local pharmacies, cuts down on the number of parking spaces required at each location, and frees up pharmacists to spend more time with patients. Santa Clara area pharmacy director Judy Thomas, PharmD, calls the CPP a big help. She said she has noticed just how helpful it is on the few occasions that the centralized system shut down because of a power outage or rare virus.
"It's overwhelming. It's just amazing the volume they take away from us," she said. Thomas said on those occasions she likes to remind Toy how much she appreciates him and his staff. A long-time Kaiser Permanente pharmacist who started the CPP in late 1996, Toy recalled Day 1 of the operation, when, with the technology in its infancy, it took the day to process about 50 prescriptions. Today, the average is about 2,300 an hour.
Veronica Surait, a pharmacy clerk, prepares pills to be loaded into bulk dispensers.
The process starts with a computer printed label. Orders are received from either the pharmacies, call center, kp.org, or are called in from members using the refill ordering system. A machine spits out an empty plastic pill bottle, and the prescription label attaches. Now the bottle has a name and destination. Next, the bottle is married to something called a "puck" because it looks like a hockey puck with a donut hole. The pucks carry infrared identification (RFID) tags embedded with routing details. For the next several minutes that puck will be the pill bottle's eyes and ears, directing it to the appropriate "pill fill." The bottle will carry it along the winding conveyer belt to giant electronic pill containers that line the warehouse like rows of colorful coffee-bean dispensers. The puck, with its RFID tag, finds the appropriate dispenser, and the system software "tells" the machine exactly how many pills to release.
When finished, the puck will carry the bottle to its next location. Pharmacists closely monitor the automated process "Every single prescription is checked by a pharmacist," Toy stressed. Filled, verified by a pharmacist, and capped, the bottles either wait in an accumulation zone to join additional prescriptions for the same patient or they travel solo to the packing area, where they will be scanned, sealed, and sent on to the mailroom.
A suspended conveyer belt resembling a miniature ski lift carries the packaged drugs through the mailroom. Using the same radio-frequency technology, the gondola knows where to drop the package. If it tips to the left, the grey bag drops into a US mail bin; a little bit to the right, and the bag will fall into one of many shipping crates waiting to be delivered to the pharmacies.
About 60 percent of the prescriptions filled in the CPP are shipped to the pharmacies, with the rest mailed directly to members. Toy said this remarkably automated process relies on three things to ensure the highest degree of quality and accuracy: barcoding, radio frequency technology, and scanning.
Oh, and Humans
A total of 255 people work at the CPP, keeping each shift running smoothly. Pharmacists check each bottle for accuracy, while pharmacy technicians load the giant pill dispensers, and pharmacy clerks pack, sort, and scan the products.
Automation is making its way into the region's pharmacies as well. "Rex" the talking pill bottle is now in many of the region's 140 pharmacies, and will soon be offered to visually impaired members at all locations. With a voice playback device built into the bottom of the medicine bottle, Rex talks to members to prevent medicine mishaps. Members press a button to hear dosage, the name of the medication, instructions, side effect warnings, and refill instructions.
Thomas said the technology, including Rex and the CPP, save money—mail order can reduce production costs by $9 a prescription, but ultimately their gift is better customer service.