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Healthcare executive 20 years, wrote Hacking Healthcare for O'Reilly... So long as this is used for routine filling of routine medications with low risks I thin

Healthcare executive 20 years, wrote Hacking Healthcare for O'Reilly... So long as this is used for routine filling of routine medications with low risks I think this can work. However it is also my opinion that Walgreens is a very, very poorly run organization. If you followed the Theranos story and documents you can see just how poorly. To the people saying pharmacists should not be involved at all, that is insane. Prescription errors are a very large source of preventable error that causes significant harm. Lots of error cannot be solved by computer because it lacks the information, like identity, drug and dosing errors. There are a lot of inputs that only a human can evaluate at dispensing time. This robotic filling, as I read it, does not necessarily prevent that. For reference, there are roughly ~110 million possible drug formulations (drug x dose x route etc) that are currently legally dispensable and distinct, in the US. Any drug can interact with any other, different dose x route x drug combinations may interact differently. A large set of the population is on dozens of drugs simultaneously. Taking into account the patients age/weight/race/level of sickness is important and makes the overall matrix very very large for raw computation. You might then say: well humans aren't good at a matrix that large either, that is in some ways true but humans are pretty good at detecting exceptional circumstances even though though they are not rotely walking that large key space. It is also true that there is a heavy weighting towards about 1,000 much more common drugs. It is not a new idea to add computers to interactions/dispensing/etc. It has been tried for 20 years, the outcome results of many efforts have been poor. A gold standard in pharmacy interactions is to maximize the amount of time between pharmacist and patient. Pharmacists aren't pill monkeys rotely stuffing things in bottles. They have important diagnostic, education and safety functions. Especially when they can see and interact with the patient. If there was any true broad economic incentive to be preventative pharmacists would take your vitals and temperature as well but currently our system does not make that economic.

mynameisvlad 4y ago
I disagree that it’s as complicated as you’re making it seem. There are only a few cases, relatively, where the “age/weight/race/level of sickness” is taken into account, and the prescribing physician would be the one that makes that call rather than a pharmacist. There’s also nothing that says that information couldn’t be transferred along with a prescription. It’s not like a centralized system wouldn’t have all that information about you, along with any other prescriptions and even non-prescription medications previously purchased with Walgreen’s (or any other pharmacy, they all do it) rewards card. A computer can also certainly be trained to identify outliers, and can certainly process complex interactions (not that there’s nearly as many or as varied and diverse as you’re making it seem) better than a human can, with the same data. At the end of the day there’s a finite number of these interactions, and while things like dosage might affect some, overall it’s groups of drugs that interact with each other which is generally looked at. Finally, at least for me, every time I get a prescription filled I get literally a 5 second conversation with a pharmacist at best. 10 seconds if it’s a new prescription with a particularly bad side effect. Suffice to say, I don’t think you’ve shown why exactly a human would be better than a machine at this job.
- flarg 4y ago
  Maybe 90 percent of medicine dispensing is without issue and you fall into that category. The other 10 percent is where a pharmacist comes in. That being said, I don't need a pharmacist to review my 4 decade long prescription for inhalers.

mynameisvlad 4y ago

I disagree that it’s as complicated as you’re making it seem. There are only a few cases, relatively, where the “age/weight/race/level of sickness” is taken into account, and the prescribing physician would be the one that makes that call rather than a pharmacist. There’s also nothing that says that information couldn’t be transferred along with a prescription. It’s not like a centralized system wouldn’t have all that information about you, along with any other prescriptions and even non-prescription medications previously purchased with Walgreen’s (or any other pharmacy, they all do it) rewards card. A computer can also certainly be trained to identify outliers, and can certainly process complex interactions (not that there’s nearly as many or as varied and diverse as you’re making it seem) better than a human can, with the same data. At the end of the day there’s a finite number of these interactions, and while things like dosage might affect some, overall it’s groups of drugs that interact with each other which is generally looked at. Finally, at least for me, every time I get a prescription filled I get literally a 5 second conversation with a pharmacist at best. 10 seconds if it’s a new prescription with a particularly bad side effect. Suffice to say, I don’t think you’ve shown why exactly a human would be better than a machine at this job.

flarg 4y ago
Maybe 90 percent of medicine dispensing is without issue and you fall into that category. The other 10 percent is where a pharmacist comes in. That being said, I don't need a pharmacist to review my 4 decade long prescription for inhalers.