2. Manchac Technologies - Overview
Over 230 DOSIS L60 & C60 robots deployed in over 170
pharmacies since 2009
Over 250 years combined pharmacy automation experience
in key positions
DOSIS is designed, manufactured, and supported in USA
(sales and service employees across the country)
DOSIS meeting the dynamic needs of LTC pharmacies,
large and small, from 200 beds to beyond 10,000 beds
Widely accepted because we make a difference
P E R F O R M A N C E I N L T C P H A R M A C I E S N A T I O N W I D E
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3. Solutions
Robotic Packaging Automations 28, 30, & 31
day single medication blister cards; Daily Rx’s,
Cycles and minimizes Pre-Packs
Consolidated labeling and zone printing
Robotic Packaging Automations 15 & 16 day single
medication blister cards; Daily Rx’s, Cycles and
minimizes Pre-Packs
Prescription Workflow and sorting solutions
P E R F O R M A N C E I N L T C P H A R M A C I E S N A T I O N W I D E
4. L60 Packaging Automation
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Fills, Seals and Labels blister cards
without constant user supervision
No user canister calibrations
Systems based controls ensure drug
accuracy
Bar code tracked medication
replenishment
Fully integrated to pharmacy
management system
Rules based platform provides flexibility
and priority prescription filling
I N N O V A T I V E S O L U T I O N S T O I M P R O V E P E R F O R M A N C E
5. DOSIS L60 Revolutionary Technology
Automatically adjusts to each pill shape & size
No user adjustments
Pharmacy can buy generics of choice instead of only
“automated” meds
No recalibration cost when changing types of medications
Purchase consumables on open market
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I N N O V A T I V E S O L U T I O N S T O I M P R O V E P E R F O R M A N C E
6. More Innovation
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• Only blister card automation system
with an phone APP!
• Notify allows monitoring of one or
more of your DOSIS facilities
• Allows for multi-site location
monitoring.
• Check out progress without being
present
• See how far into to the night DOSIS
is still working filling cards!
7. mPAQ Printing
Fully integrated patient labeling and
zone printing for all printers dedicated to
labeling in the pharmacy
Consolidated, color coded, patient
labeling provides fast consistent and
uniform labeling of prescriptions
Reduce costly time-pass and auxiliary
labeling steps for blister card
completion
Reduce label material costs
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I N N O V A T I V E S O L U T I O N S T O I M P R O V E P E R F O R M A N C E
8. 8
Sorting and Tracking made simple
Intuitive workflow dashboard lets you
see daily activities and bottlenecks
Integrates with current workflow
software available in pharmacy
management platforms
Touch to light toting technology ensure
accurate placement in delivery totes
cTRAQ Sorting Solution
I N N O V A T I V E S O L U T I O N S
9. DOSIS C60 fills 15/16 count
narcotics blister cards
Control features
Inventory reports
Shift audits
Access control in a fully
locked, automated packaging
robot
C60 Narcotic Packaging Automation
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I N N O V A T I V E S O L U T I O N S T O I M P R O V E P E R F O R M A N C E
10. Model Approach
Leverage DOSIS strengths to:
Allocate pharmacy work based on most efficient filling process
Provide more effective and consistently accurate labeling
Enable better use of Pharmacists’ time
Allows your technicians to work on delivering new orders, not filling cards
How?
Interface DOSIS with FrameworkLTC system to fill patient-labeled cards all
day, every day; whether for daily scripts, cycles or pre-packs
Maximize daily filling and dispensing ; reduce the ‘days on hand’ of pre-pack
to minimize labor & reduce inventory costs
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P E R F O R M A N C E I N L T C P H A R M A C I E S N A T I O N W I D E
11. Why Automate?
High-volume operations of any type become more chaotic and
error-prone as labor is added
Properly implemented automation systems
Provide a structured workflow to remove chaos and errors
Use technology to remove expensive/error-prone manual tasks
Allow a systematic, predictable way to increase capacity
Accommodate changing business needs over time
Freeze / Stabilize labor force and associated cost
Enable key employees to be more productive. Let your good
people get more done & become less dependent on average staff.
P E R F O R M A N C E I N L T C P H A R M A C I E S N A T I O N W I D E
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12. Why Automate with DOSIS?
**Assuming your pharmacy is in the top 25% of most efficient US long term
care pharmacies:
$ 1.37: Your current cost per script for the work DOSIS does
- $ 0.43: Cost with DOSIS @ 10,000 scripts* per month
*(Purchase, Service, Technician time)
$0.94: Savings per script with DOSIS
Single L60 robot operated 24X7 can produce 12,000 to 14,000 per month
DOSIS L60 is capable of producing around 700 packages per day per
machine
Average total pharmacy tech interaction under 2 hours per day!
V A L U E T H R O U G H C O S T R E D U C T I O N
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**Analysis of Costs to Dispense Prescriptions in Independently Owned, Closed-Door LTC Pharmacies. Norman V. Carroll
et.al. Journal of Managed Care & Specialty Pharmacy: Vol. 20, No. 3 March 2014.
13. Manchac’s
Recommendations
Recommendations
based on usage
data, observation of
typical pharmacy
workflow, and
Manchac’s
experience operating
in 200 other
pharmacies.
E A R N I N G T R U S T O N E S T E P A T A T I M E
Strategic Plan
Deploy L60 robots to optimize pharmacy
resource and capacity by
1. Reducing pharmacy tech hours required for
daily hand packaging, labeling and
organizing
2. Maximizing pre-packaging operation to
highest volume meds potentially leading to
decreased ‘days on hand’ and increased
inventory turns.
3. Provide effective zone printing with enhanced
time pass and auxiliary labels
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V A L U E T H R O U G H C O S T R E D U C T I O N
14. Controls Cage
Optimized
Production
Work Flow
- DOSIS receives all
transactions & fills or
prints
- All labels can have
built-in med-pass
colors and auxiliary
instructions
- Pre-packs limited to
SKUs used more than
10 times daily
E A R N I N G T R U S T O N E S T E P A T A T I M E
DOSIS
Site Server
Label
Printer
Label
Printer
FrameworkLTC
DOSIS L60
#3
…
…
PV 2
Pre-packs
Labeling of Pre-
packs
Manual Filling of
Extemps
Sorting, Delivery, …
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Top
SKUs
Label
Printer
DOSIS L60
#1
DOSIS C60**
Update Workflow
as scripts are Printed and FilledHL7 or
Batch Export (all scripts)
mPAQ Printing
(non-robot scripts)
V A L U E T H R O U G H C O S T R E D U C T I O N
cTRAQ
15. Minimize Inventory Pre-packing
• REDUCE pre-packing overall in your pharmacy!
• Only pre-pack high-volume SKU’s
• Continue to use existing pre-pack equipment to minimize
labor producing large batches of HIGH VOLUME SKUs.
• Pre-packing lower-volume SKU’s is not cost effective
• Large number of pre-pack SKU’s lowers the pharmacy’s
inventory turn-over rate!
• DOSIS benefits more than just filling cards hands-free!
O P T I M I Z E E X I S T I N G P A C K A G I N G R E S O U R C E S
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16. DOSIS Implementation & Support
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Manchac’s Implementation and
Support team will guide
FrameworkLTC users through the
planning phase and coordinate
meetings, dates, and deliverables.
Manchac employs a robust
support infrastructure of people,
tools, and processes.
Back-office dashboard, Overseer,
performance monitoring and
reporting services of the DOSIS
fleet.
V A L U E T H R O U G H C O S T R E D U C T I O N
17. Highlights of Typical
DOSIS Implementation
-Manchac will guide
FrameworkLTC
users through a
smooth
implementation
-Aim for “big picture’
then refine for the
exceptions. Work
flow rules can be
modified or replaced
as needed
throughout the
integration process
and beyond.
E A R N I N G T R U S T O N E S T E P A T A T I M E
Label
Printer
Ongoing Support
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Premises
Checklist
Kickoff
Delivery &
Installation
(1 day)
IT
Checklist
Consumables
Ordered
Work Flow
Questionnaire
Work Flow
Meeting(s)
On-Site
Training
& “Go Live”
(min. 3 days)
Weekly Follow-up
Meetings
(min. 6 weeks)
•Installation & inspection
•Connectivity (network,
FrameworkLTC, Manchac)
•Daily Operation
•Reporting
•Troubleshooting
•Work Flow configuration testing
PREPAREEXECUTEDEPLOY
V A L U E T H R O U G H C O S T R E D U C T I O N
18. - Each deployed
robot sends
status updates
every 10 minutes.
- Remote
diagnostics allow
for efficient &
accurate
troubleshooting.
- Support Services
include all parts,
labor, & updates.
- Modular design
minimizes repair
time.
DOSIS Support
V A L U E T H R O U G H C O S T R E D U C T I O N
19. Cut Labor and Inventory Costs
Daily/ On-Demand Refills/ Cycles Operation- DOSIS
Pre-packs and manual fills- evaluate and manage to lengthen runs of
high volume medications and reduce inventory carrying costs
Purchase and Pre-pack an optimal supply; shift lower volume card
counts and hard to plan SKUs to DOSIS
Extemporary drugs and hard to pack SKUs traditionally consume a lot of
labor, free up tech time with DOSIS so the best techs get more done
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V A L U E T H R O U G H C O S T R E D U C T I O N
20. Next Steps
Consult with the DOSIS team
about your operational challenges
Identify the operating model for
DOSIS
Show the positive impacts.
Scale DOSIS system based on
card volume & labor model.
Determine deployment plan
Create value by reducing labor,
inventory hand and optimize
existing pharmacy infrastructure.
V A L U E T H R O U G H C O S T R E D U C T I O N
Editor's Notes
Over the last 30 years LTC pharmacy has seen many defining moments. Clearly regulatory change has beat us all into a state of efficiency focused thinking. Prior to 1987 blister card packaging was completed by hand, pharmacy technicians packing by hand to complete the pharmacy process.
1987 brought the introduction of Pre-packaging machinery, now pharmacies could produce large numbers of card so senior technicians could pick and stick patient labels. This generated some labor savings.
In 2003 the first OnDemand packaging systems were introduced, now order could be sent to the packaging machine, producing a patient specific blister card. This produced some additional efficiencies, but the machine were big, complex and expensive.
Today pharmacy packaging is in a state of automation evolution. Big, complex and expensive will not work for most pharmacies, that’s why
DOSIS is the fastest selling pharmacy automation for blister packs in the US today. Dosis Management, after years of design engineering work for Mckesson Automation, realized that LTC pharmacy wasn’t using automation in the manner retail and acute care models were.
Suppliers like MTS and Rx Systems were focused on selling quality consumables. Justifiably, automation was designed to drive consumable sales. AutoMed and TCGRx were operating in a similar model for pouch dispensing. In retail and acute care pharmacy, vial filling and unit dose packaging were the areas of pharmacy that suppliers automated. Suppliers like McKesson, Script Pro, Prata and others were and are automation suppliers, focused on operational efficiency.
Thus the focus for Dosis automation design can be targeted for optimization of pharmacy operations. At DOSIS, we identified a gap in pharmacy automation and built a system to meet the dynamic and changing needs of LTC pharmacy. Most importantly we addressed the issue of packaging blister cards continuously all day, without constant human intervention with the packaging device.
Dosis is a solution build around a platform of interoperability. Dosis packages blister cards; whether for general dispensing or for narcotics; manages label printing across the pharmacy providing a uniform label format at all pharmacy stations and coordinates and manages the sorting and toting process.
Our newest product Dosis Notify is a telephone app that receives messages directly from the Dosis L60. If there is a stoppage of work you will know it and can take care of it immediately.
DOSIS L60 the flag ship solution to packaging blister cards.
Envision one pharmacy technician per shift operating 5 DOSIS L60 machines, producing 180 to 220 patient specific, filled sealed and labeled cards per hour. When they go on break or lunch, the machine does not stop by the way. We have a customer with 2 techs managing 10 machines, operating 10 hour, 5 day work weeks.
The beauty of DOSIS L60 is inner operability, we leverage existing infrastructure, to optimize operations, reduce labor and inventory days on hand.
Some of the largest independent pharmacy operators and multi-site groups are using L 60’s.
DOSIS L 60 uses canister technology harnessing a software based vision system to control, count and delivery medication to each blister cavity.
The advantage - No returns of cassettes or canister to the supplier for re-calibration,
The benefit - Maximize purchasing potential by being able to swap NDC’s in a canister in minutes. No longer are you buying medications specific to your packaging machines. You purchasing team can strategically source medication purchases for best price.
Technology should improve Quality of Life for the owner, pharmacist and technician.
Our customers who run their machines at night, unattended, while the pharmacy is closed have asked for a way to the monitor progress of the machines.
Dosis Notify is quick and easy to use. If you have an I phone you could be monitoring progress in the pharmacy right now.
mPAQ Printing is an extension of the DOSIS solution.
With consolidated labeling and zone printing we can further streamline packaging operations and reduce labor costs.
DOSIS can send orders for pre-packed perscriptions directly to that zone in the pharmacy reducing unnecessary movement of inventory through out the pharmacy. Orders for non orals can be sent to a specific work station for those perscriptions.
Uniform labeling that includes ‘Time Pass’ labels and auxiliary labels reducing laborious secondary labeling and speeds PV2 processes further reducing labor costs per card.
Sorting and Toting is an area of pharmacy where mistakes often happen, cTRAQ uses proven touch to like technology to insure accurate tote placement.
The system can be integrated with existing work flow management systems.
Control substance packaging and dispensing continues to be targeted by DEA and BOP surveyors.
Whether dispensing narcotics in a 16 dose card or a 30 dose card DOSIS provides the most secure, automated packaging platform available today.
Self contained packaging allows pharmacist control from bulk bottle to completed package. Inventory control and shift audit reporting provides hard copy log reports when needed per state regulations.
Our Model is not complex but very effective.
We realize there are several ways to package blister cards. Each method carries its own costs, advantages and disadvantages. At DOSIS we integrate our systems to meet specific goals for the project, (ie automate 50% of daily dispensing, or for a specific volume); also we evaluate existing infrastructure to maximize existing systems (pre-pack or other OnDemand technology) to meet daily needs.
During off peak hours, DOSIS can then complement existing packaging systems by completing cycle fill perscriptions or pre-pack lower volume items required for the next day. This leave high capacity systems free to maximize those systems packaging advantages.
The goal lower labor costs, more effective use of labor pool, lower inventory days on hand and better use of R.Ph. time.
Automation needs to meet specific goals, that may vary from pharmacy to pharmacy. But in todays environment there are a few consistent challenges all pharmacies face;
Without structured work flow chaos exists
Without dependable labor and packaging capacity customer satisfaction suffer
Reimbursement models are evolving not necessarily in the favor of pharmacy and spreads will be further compressed
The last bastion of control in pharmacy maybe labor;
Inner operable automation is the key to customer satisfaction and value (MAR, EMAR, PO, PRN logs)
Pharmacy packaging must move towards a similarly integrated environment.
At DOSIS we believe we can save you nearly a dollar for every script filled on a DOSIS L60.
A 2014 report in the Journal of Managed Care and Specialty Pharmacy found that labor cost to package blisters cards was around $1.37
The acquisition cost and estimated labor of Dosis running 10,000 scripts per month are $0.43. Now we all realize there are other variables to consider here, labor rates, consumable costs ect…
So the question is are you interested in doing the analysis to determine what your saving could be.
More then ever your strategic business operations plan must address optimization of resources and tools
Our goals are to Optimize Pharmacy Resources
Reduce total tech hours required to package, label and organize blister cards daily
Maximize investments in high volume pre-pack machinery
Reduce days on hand inventory and increase inventory turns
Consolidate label printing to one format for every work zone
This is an example of a 6500 bed pharmacy using Frameworks; where we deployed 3 DOSIS L60’s and mPAQ printing.
Pharmacy volume: 70,000+ blister cards per month
3 robots filling daily scripts and cycle fills, robots running 16 hours per day (less on weekends)
Monthly robot production: 38,000 patient-labeled blister cards (54%)
Total monthly staff interaction: 175 hours per month (1.02 FTE technicians)
Stocking medications, loading robot consumables, re-prioritizing the DOSIS queue, sorting finished cards
Per robot: 12,670 patient-labeled blister cards for 58 hours of interaction
or 216 patient-labeled blister cards per technician hour
Bottom line: 1.0 FTE technician producing equivalent of 9.5 technicians packing by hand
DOSIS is not designed to replace those systems in place today, unless they no longer perform to standard, it is designed to complement other systems and optimize work flow.
In that regard lower volume or expensive pre-packs can me moved to daily dispensing on Dosis L60, potentially reducing inventory costs.
Existing prepack machinery can be used for longer runs of low cost generics.
Our process has been refined and improved over 230 robot installations.
As we have gotten bigger we have added significant resource in support. Like all automation suppliers we are better today because we have gotten bigger, the demands and support of our customers has challenged us and the company has responded , I believe.
Installation, Implementation and Integration are critical, and we will be responsive.
The process begins well before the machine has arrived. The process continues for as long as the system is on line and under support agreement.
Designated project teams are focused on your 4 key areas prior to delivery;
Site preparation
IT and connectivity
Workflow and operations
Consumable preparation and delivery ( MTS and Rx Systems)
Installation and Implementation take place on site over three days.
Integration can last as much as six weeks, our rules based system allow us to, define, redefine and continually address your constantly evolving service models.
One of the real advantages of DOSIS is ‘Over Seer’. Most automation in use today requires support log into the machine to perform diagnostics and provide support. A reactive approach.
DOSIS is predictive in that the system reports performance data to the office to every 10 minutes.
This is a superior model allowing support to identify part failures well in advance of a work stoppage.
Our service and support agreement offer a perpetual warranty on the machine.
In closing, we realize that each of you have a limited capital budget to work with. The demands on your pharmacy for EMAR, carts, remote automated dispensing cabinets, software and systems upgrades go far beyond the budgets I am sure.
But based on where we are in LTC pharmacy, your top line in pretty much drive by growth, because revenue per patient served is not exploding, the last area where you may be able to improve the bottom line is to drive costs out of your operation; labor and inventory.
Take a hard look at Dosis and let us meet your expectations.
