Selecting automation technology: How to simplify a difficult decision

State and federal government as well as large employers are encouraging hospitals to proceed with the process of automating their medication delivery systems in order to enhance patient safety. This puts pharmacy administrators face-to-face with the daunting task of determining which technology is best for them. Whether it's a system that enters orders, counts pills, provides drug information, or dispenses medication, the process of choosing from an endless number of vendors can be overwhelming.

According to David Hicks, R.Ph., M.B.A., automation director at McKesson Medication Management, the process can be simplified by taking a step-by-step approach that also eliminates the marketing hype by which the vendor is simply trying to make a sale. "The pharmacy must envision where it wants to go and determine its needs," he said at the ASHP Summer Meeting 2002, where he helped facilitate a pharmacy automation learning community. Is the organizational goal to lower costs, decrease medication "turn-around" time, or improve patient safety? Answering these questions is the first step, Hicks added.

Once pharmacy expectations are realized, key stakeholders should be identified and involved in the project every step of the way. Representatives from information services, administration, finance, and all affected patient service departments are often included. Initially, the group should identify the requirements, or criteria, of the "ideal" system from all perspectives. The resulting criteria are then packaged in the form of a request for proposal (RFP) to be submitted to various vendors for bids.

The RFP should inform the vendor what is important to your hospital and allow easy understanding on your part when the response is received, Hicks said. Roughly 100 criteria should be submitted to each vendor, and the format should be designed to provide one-word responses, he added. This will curb long, narrative answers that are confusing and more difficult to score.

Defining what answers are acceptable on a scale of one to 10 is helpful, suggested Ronald E. Mortus, R.Ph., M.B.A., FASHP, regional director of pharmacy services, Cleveland Clinic Health System, and it will help make comparing different vendors' products easier. A sound scoring system must be developed, and each criterion weighted for its priority. Upon receiving the vendor's responses, an overall score can be calculated by multiplying the acceptability score by the priority value for each question. The products are then added together to give an overall score for the vendor.

The RFP document should include five major categories of criteria for most types of pharmacy automation—technical requirements, vendor qualifications, software functionality, safety, and financial considerations, according to Hicks.

Providing background information on your existing system and listing both the functional and technical requirements of the new system are essential. The vendor should also provide a full list of necessary devices and specify which are vendor-provided versus facility-provided.

The purchasing facility normally demands the vendor be able to provide HL-7 compliance data streams for interfaces, which enable data packets to be sent to other hospital systems, such as the Medication Administration Records (MAR) systems. How the new technology will interface with existing systems is extremely important.

"The lack of standards for information systems often results in key hospital systems' not being able to communicate with one another," said Kasey Thompson, Pharm.D., director, Center on Patient Safety, ASHP. For example, if a new, high-priced, computerized prescriber order entry (CPOE) system doesn't "talk" to the pharmacy and laboratory systems, important safety information will be missing, he added.

Meeting technical requirements may mean significant facility renovation for the hospital, which can be expensive and must be included in the overall cost of the purchase.

How should hospitals request vendor and product information in the RFP? Obtaining references and contacting users of the technology will help determine a firm's reputation and ability to deliver and support the product. The financial stability and regulatory conformance of each vendor should also be examined.

Keep in mind that staff will need to be trained to use the new technology. How much time is necessary to train pharmacy staff, physicians, nurses, and other users? Does the vendor supply the training materials? What costs are involved in training for the vendor and the hospital?

Experts agree that the software functionality of the product being considered is the most important section of an RFP and takes the most effort to develop. The purchaser needs to thoroughly understand current or planned operational processes in order to write these criteria, according to Hicks. Include questions on all the functional requirements, such as order entry, alert checking, item tracking, billing, and reporting.

"Provide the vendor with detailed expectations of the automation you want, such as output capacity in units per hour," advised Mortus. For example, a syringe-filling machine should state the number of doses that can be filled per hour, as well as the number of doses that can be run before you must refill the supplies, such as labels, syringes, and packaging material, he added.

Safety features must address both patient and operator safety. Detailed questions should be included in the RFP that inquire about workflow design, alert checking, bar-coding, and other areas, Hicks explained.

Financial criteria should identify all of the one-time and ongoing costs for the projected life of the product, including hardware, software, interface, support, and labor costs. Often overlooked are the maintenance costs of keeping the new automation running. To determine the full financial impact of the new technology, Mortus suggested mentally following the product through the medication delivery system, considering the impact of the change at every step of the way.

The goal, according to Hicks, is to send RFPs to no more than six vendors. And this can ideally be narrowed to three or four based on the RFP responses alone.

Developing and submitting RFPs is only one part of the process, however. Inviting vendors to demonstrate their product to a wider group is often the next step, said Mortus. Remind vendors to demonstrate only products that are available today and avoid "future" versions, he recommended. Site visits and reference checks are other ways to narrow the field.

Although it can be time consuming, the importance of developing a good RFP and selecting and implementing pharmacy automation the right way is second only to hiring and training staff, Hicks said. "To be successful, a pharmacy director has to do a good job of managing this process. The planning and structure that a good selection process require greatly improve the chances of a project's success."