Robot for compounding intravenous medications helps improve safety and efficiency

UCSF Medical Center’s Pharmacy Leadership team wants someone to build these products

By Desiree Matloob and Priyanka Agarwal

As part of a series of articles in which we share what we’ve learned from UCSF health system stakeholders about their pain points and technology needs, The Center for Digital Health Innovation (CDHI) at UCSF met with Rita Jew, Director of Pharmacy at UCSF Medical Center, along with the Med Center Pharmacy leadership team, to understand what their department’s innovation priorities are. We’ve listed some of these below.

Why are we sharing this? UCSF’s Center for Digital Health Innovation was formed three years ago to help improve patient care using technology, and we’d like to see more collaboration between health systems and entrepreneurs in healthcare. Please reach out to us if you’re working on any of these issues!

Price transparency for patients & providers

Physicians currently lack a tool that allows them to have insight into the true costs of a drug for a patient. The current process for determining cost is highly manual and labor intensive, requiring extensive paperwork and approval by insurance companies. This is particularly detrimental when it comes to high-cost pharmaceuticals like oral chemotherapy, in which a treatment prescribed in the inpatient setting can cost much more in the outpatient setting once the patient is discharged (due to differing coverage and reimbursement models in the in vs outpatient setting). In the midst of managing life-threatening illnesses or end-of-life care, patients often lack knowledge regarding the costs they will bear. Beyond price, prescribers and patients should also be able to clearly understand clinical efficacy of drugs, as well, with the ideal tool providing information on cost based on insurance coverage and also clinical efficacy.

Inpatient medication delivery management and delivery

Another priority area is managing medication batch production and medication delivery to ensure drugs are distributed appropriately among different UCSF campus hospitals. Routine medications at UCSF are prepared centrally in an off-site pharmacy and then distributed to our various hospitals. There is currently not a great system for tracking medication dispatch and delivery. UCSF Medical Center currently also experiences ~25% medication waste due to a multitude of reasons including providers changing an order after a medication is prepared. UCSF is currently exploring lean production solutions to reduce medication waste, improve safety and accuracy through barcode scanning technology and that provide real-time tracking updates from the delivery process, though additional solutions that help us manage production and delivery would be great.

Pharmacy dashboard for operations & clinical staff

Pharmacists are still routinely copying information from the electronic health record (EHR) onto paper so they can monitor the patient in a more robust way then what the EHR allows. What clinical staff need is a more interactive report that allows them to easily pull information from the EHR, see trends with medications and corresponding lab values over time, and glean insights about patient interactions with medications while they are titrating them up and down. Such a dashboard would need to be flexible and customizable for different disciplines. From an operational standpoint, pharmacists also need to be able to know the workload for upcoming shifts beforehand so they can properly allocate their resources. Pharmacists at UCSF off-site pharmacy currently have no idea what their day is going to look like since it is hard to see at a glance the medication needs for an upcoming shift — and they are tasked with filling all the prescriptions for every UCSF campus and clinic. With the right tool, they would be able to identify trends in their workload over time and have just-in-time information to enable proper resource allocation and improved efficiency.

Patient-specific drug education

Medication information available for patients is currently very generic, and not specific to patients’ conditions and needs. UCSF is interested in solutions that can go beyond the standard educational video and tailor it to the institutional needs of their health system, particularly for those with complex conditions.

Opioid abuse management

Opioid abuse is a huge problem, with more than 165,000 deaths between 1999 to 2014 attributed to overdoses related to prescription opioids. To combat their abuse within hospitals, our pharmacy would like to be able to link what is ordered to what is taken out of the automated dispensing cabinets and the record of administration in the EHR in order to detect any unaccounted for withdrawal from the automated dispensing cabinets, and alert management staff of the discrepancy.

We hope this has been a helpful introduction to some of the issue areas UCSF Pharmacy is looking to tackle in order to improve the experience and outcomes for patients, providers, and pharmacy staff. We look forward to hearing about your solutions in these spaces!

Thank you to Michael Blum, Rhona Snyman and UCSF Department of Pharmaceutical Services.

Desiree is Manager of Startup & Early Stage Partnerships at UCSF, and previously led the healthcare technology sector for Israel’s Economic Mission to the West Coast.

Priyanka is a physician at UCSF where she sees patients in the Division of Hospital Medicine. She also leads CDHI’s startup and early-stage company partnerships.