Delivered at Health Connect Partners conference in Chicago October 17, 2016. The presentation covers some of the current technology used in acute care pharmacies, as well as some technologies that I believe, have the potential to change the way pharmacists will practice in the near future.

1. THE FUTURE OF PHARMACY:
Using Technology to Drive Practice Change
Jerry Fahrni, Pharm.D.

2. Image source: Jerry Fahrni, Pharm.D. – All rights reserved

3. Literature supporting
“clinical pharmacy” is
plentiful

4. “...Develop and disseminate a futuristic practice
model that efficiently utilizes pharmacists as
direct patient care providers ...”

5. 5 5
“I’m over here…”
“…uh, you should be here”

6. Pharmacy practice, especially practice
within the acute care setting, is largely
unchanged from what it was 30 years
ago. While it can be asserted that new
drugs have entered the market, more
pharmacists spend some or all of their
time in clinical practice, and, to some
degree, new technologies have become
available, too many pharmacists
continue to practice in the acute care
settings that provide roughly the same
services, using the same practice model
now, that they did in 1976....an obsolete
practice model.
“
Technology-enabled practice: A vision statement by the ASHP Section of Pharmacy Informatics and
Technology Am J Health Syst Pharm 2009 66: 1573-1577

7. "You know, like nunchuck skills, bo hunting skills, computer hacking skills. Girls
only like guys who have great skills." - Napoleon Dynamite

8. Medication Errors
Medication Errors That
Adversely Affect Patient
Care Outcomes
Net No. of Favorable
Outcomes Associated
with Each Variable
Pharmacist location
Decentralized ↓ ↓ 5
Centralized with ward visits ↑ ↑ -2
Centralized ↑ ↑ -2
Adopted from Table 4 - Clinical Pharmacy Services in U.S. Hospitals in 2020 Bond et al, Pharmacotherapy 2004

9. Traditional Storage IV Room
Refrigerated Storage Controlled Storage

10. Traditional Storage
Controlled Substances
Refrigerated Storage
I.V. Room / Cleanroom
2
3 4
Static shelving
Carousels
Inventory management systems
Medication trays/carts
Unit-dose packagers
Automated packagers
Robots
Bar code scanning
1

11. Traditional Storage
Controlled Substances
Refrigerated Storage
I.V. Room / Cleanroom
1
3 4
Static shelving (“non-controlled”)
Carousels (“non-controlled”)
Inventory management systems
Medication trays/carts
Unit-dose packagers
Automated packagers
Robots
Bar code scanning
2
Static shelving (refrigerated)
Carousels (refrigerated)
Inventory management systems
Bar code scanning
RFID technologies

12. Traditional Storage
Controlled Substances
Refrigerated Storage
I.V. Room / Cleanroom
1
4
Static shelving (“non-controlled”)
Carousels (“non-controlled”)
Inventory management systems
Medication trays/carts
Unit-dose packagers
Automated packagers
Robots
Bar code scanning
3
Static shelving (refrigerated)
Carousels (refrigerated)
Inventory management systems
Bar code scanning
RFID technologies
2
Static shelving
Carousels
Refrigerators
Inventory management systems
Bar code scanning

13. Traditional Storage
Controlled Substances
Refrigerated Storage
I.V. Room / Cleanroom
1
3
Static shelving (“non-controlled”)
Carousels (“non-controlled”)
Inventory management systems
Medication trays/carts
Unit-dose packagers
Automated packagers
Robots
Bar code scanning
4
Static shelving (refrigerated)
Carousels (refrigerated)
Inventory management systems
Bar code scanning
RFID technologies
2
Static shelving
Carousels (yes, really)
Refrigerators
Inventory management systems
Bar code scanning
Static shelving
Carousels
Refrigerators
Inventory management systems
Bar code scanning
IV workflow management systems
IV compounding robots

14. SAFETY
ELIMINATION OF
BIAS
REDUCE MULTI-
TASKING
IMPROVE DATA
COLLECTION
TRANSFORM THE
ROLE OF THE
TECHNICIAN
STANDARDIZE
WORKFLOW
CUT COST
IMPROVE
EFFICIENCY
Image source: Jerry Fahrni, Pharm.D. – All rights reserved

15. Optimizing Central Pharmacy Dispensing Technology. May 2016. PP&P:13(5)

16. SAFETY
ELIMINATION OF
BIAS
REDUCE MULTI-
TASKING
IMPROVE DATA
COLLECTION
TRANSFORM THE
ROLE OF THE
TECHNICIAN
STANDARDIZE
WORKFLOW
CUT COST
IMPROVE
EFFICIENCY

17. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Medication Tracking Systems
Tray Management Systems
IV Workflow System
Waste Management
Automated Storage/Retrieval
Robots
Carousels
14%
15%
19%
33%
36%
38%
87%
Adapted from: State of Pharmacy
Automation. Pharm Purch Prod. 2016

18. Diffusion of Innovation

19. Sources: U.S. Bureau of the Census (1970 and various years); Cellular Telecommunications Industry Association (1996); The World Almanac and Book of Facts (1997) - http://www.glencoe.com/sec/socialstudies/economics/econtoday2001/pdfs/C22-02C-820489.pdf

20. Adoption of Smartpumps, BCMA, CPOE graphed as percent adoption over time (data source: AJHP - Vol 72 Jul 1, 2015)
Graph: Jerry Fahrni, Pharm.D. – All rights reserved

21. Have a clear, unambiguous advantage in either effectiveness or cost-effectiveness
Are compatible with the adopter’s values, norms, and perceived needs
Are perceived as simple to use
Knowledge to use innovation can be codified and transferred easily
When the technology can be refined and modified by the adopter to meet their specific needs
Carries a low degree of uncertainty, i.e. they are perceived as having little risk.
Observable benefits
It is relevant to the user’s work and improves task performance
Offer trialability - users can experiment on a limited basis
Technology offered as an “augmented product”
Greenhalgh, et al. The Milbank Quarterly, 82(4), 581–629.

22. THE FUTURE
Image source: Jerry Fahrni, Pharm.D. – All rights reserved

23. Augmented Reality

24. Pharmacogenomics

26. Sensors and mHealth

27. External sensors - blood-pressure cuffs and pulse oximeters
Wearables embedded in clothing or accessories
Epidermal sensors, such as patches and digital tattoos
Ingestibles embedded in pills that dissolve
Tissue-embedded sensors - pacemakers and defibrillators
Blood-sampling sensors, such as glucose meters

28. Subdermal Sensors

29. Nanotechnology
http://www.medgadget.com/2016/09/nanoparticles-made-building-blocks-integrate-multiple-chemo-agents.html

30. Selectively perforate bacterial cell membrane without affecting host cells
Release antibiotic in presence of infection
Target antibiotic to attack specific bacterial antigens
Gold coated nano shells heated up with light to destroy cancer cells
(Nanobullet)
Smart Insulin – “Glucose Sensitive Insulin”
Nano-artificial pancreas
Biodegradable nanoparticles that release growth factors and angiogenic
factors to improve bioengineering of heart or lung tissue

31. The first 3D-printed drug to win FDA approval
3D Printing

32. “It's like drinking from a fire hose”
~ Alfred Huger

33. PeterDiamandis
“

34. Professionals entrusted with the delivery and
administrations of pharmaceuticals have a
fundamental responsibility
to identify and implement interventions that will
improve patient quality outcome measures and also
reduce overall health-care costs. These interventions
include timely and judicious use of
therapeutic and technological advances
Meyer GE, et al. AJHP. 1991 May 1;48:953-966
“

35. THE FUTURE OF PHARMACY: Using Technology to Drive Practice Change
Jerry Fahrni, Pharm.D. || 559.838.6014 || @JFahrni