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Sharone Wang on the Future of Pharmacy Operations · Taking The Supply Chain Pulse

• 0:05
  Speaker 1: Hello again everybody.
• 0:06
  Speaker 1: This is Fred Kranz from St Onge here with another episode of Taking the Supply Chain Pulse.
• 0:11
  Speaker 1: Today we have one of our own St Onge folks on the call, sharon Wang, one of our newest employees and a person who has a great background in pharmacy.
• 0:21
  Speaker 1: Sharon, thanks for joining us.
• 0:24
  Speaker 2: Oh, I'm so happy to be here.
• 0:25
  Speaker 2: Thanks for having me Good.
• 0:27
  Speaker 1: Well, I was talking with Sharon a few minutes ago before we started, and I always have a shortcut.
• 0:33
  Speaker 1: I go on LinkedIn and look up people's background and so it appears I know something about them before we start talking.
• 0:39
  Speaker 1: And I tried to do that with Sharon and there is no Sharon Wang on LinkedIn, and I thought, oh, there were like three Sharon Wangs.
• 0:44
  Speaker 1: And I tried to do that with Sharon and there is no Sharon Wang on LinkedIn, and I thought, oh, there were like three Sharon Wangs and I thought perhaps she just cut her name off and anglicized that first name a little bit.
• 0:52
  Speaker 1: But nope, it turns out that she was none of those people.
• 0:57
  Speaker 1: So, sharon, tell us about yourself, your background and how you got here to St Onge.
• 1:02
  Speaker 2: Yeah, of course, of course.
• 1:04
  Speaker 2: So my background is in pharmacy.
• 1:06
  Speaker 2: I am a pharmacist.
• 1:08
  Speaker 2: I did my undergraduate at University of California, san Diego.
• 1:12
  Speaker 2: My degree was in biomedical engineering, and after that I knew that I wanted to enter healthcare in some capacity and I think, like many students at that age, you have a whole bunch of choices that you can really go into.
• 1:31
  Speaker 2: And I had seen pharmacy and I thought to myself like, yeah, I can see myself doing this.
• 1:36
  Speaker 2: And prior to that I really didn't have much exposure to pharmacy other than, I think, what usually the general public has, which is, you know, you go to CVS, you go to Walgreens, you pick up your prescription.
• 1:47
  Speaker 2: So that was kind of my understanding of it in the very beginning.
• 1:50
  Speaker 2: So I went to Texas Tech School of Pharmacy and I earned my doctorate of pharmacy over there and basically after that I was like, okay, like you know, let's, let's try this.
• 2:04
  Speaker 2: And so my first job was actually in retail.
• 2:08
  Speaker 2: So I did a, I did a sit at CVS.
• 2:10
  Speaker 2: Pharmacy got my bearings.
• 2:12
  Speaker 2: It was a great experience, honestly, because I think retail it really trains you to put yourself in the customer's shoes and the patient's shoes, and I think a lot of patients they have a lot of frustrations with the just the whole healthcare churn.
• 2:30
  Speaker 2: You know you go to the doctor's office and you got to go get your prescription and sometimes there's barriers in between, and so it was a really great experience and just trying to understand just what we all experience in terms of utilizing our healthcare resources.
• 2:46
  Speaker 2: And after retail, I went to go work for a hospital and so since then I've really been in inpatient hospital pharmacy and through my yeah, through my inpatient career, I've had opportunities in management positions, and so I was doing that for a little bit and I enjoyed that.
• 3:07
  Speaker 2: You know, you get more of a I guess like a bird's eye view of things.
• 3:13
  Speaker 2: Obviously, you're also integrating the business side and just making sure that you're on budget.
• 3:19
  Speaker 2: After that, I was thinking to myself, like you know, I could continue doing this or I can really try to find something that perhaps is still pharmacy related, but maybe a little pharmacy adjacent.
• 3:56
  Speaker 1: And this opportunity came up and it and hopefully build better pharmacies that really the end user can really appreciate.
• 4:00
  Speaker 1: Yeah, you know that's an interesting perspective because a lot of times people that design things don't have any real background or work experience in the, in the modalities or the things that they're designing.
• 4:11
  Speaker 1: So why don't you tell us what roles pharmacies play in health care?
• 4:13
  Speaker 1: And you know what do.
• 4:15
  Speaker 1: What do the pharmacy and pharmacist staff do?
• 4:18
  Speaker 2: Yeah, I think that this is a great thing to just try to bring more education to Like myself once again.
• 4:28
  Speaker 2: When I was a student, really the only interaction I ever had with pharmacies or pharmacists was, I think, what the general public kind of sees.
• 4:36
  Speaker 2: You know, you're just corner, street corner like pharmacy with CVS, walgreens, walmartmart.
• 4:43
  Speaker 2: You know that type of interaction.
• 4:45
  Speaker 2: But I think, especially after I entered the pharmacy field, you find that it's a lot more expansive than just the retail setting.
• 4:53
  Speaker 2: So of course, you know, retail is definitely one large industry for us.
• 4:57
  Speaker 2: Um, there's a lot of uh when pharmacists work in hospitals.
• 5:02
  Speaker 2: There's a lot of roles there.
• 5:03
  Speaker 2: So, for example, they could be responsible for medications in the hospitals, dispensing medication in the hospital while the patient is there, but also so we have a lot of specialties too in pharmacy.
• 5:17
  Speaker 2: So people go on to do residencies, they go on to specialize in a certain field, they go on to specialize in a certain field.
• 5:36
  Speaker 2: So you might have, for example, on a hospital bone marrow transplant team.
• 5:40
  Speaker 2: You might have a pharmacist who specializes in you as the patient.
• 5:44
  Speaker 2: If you are getting any type of chemotherapy.
• 5:47
  Speaker 2: You just feel much more assured that you have a great team behind you, not only your physician but also, let's say, your oncology specific nurse or your oncology specific pharmacist.
• 5:59
  Speaker 2: So there's that avenue as well.
• 6:03
  Speaker 2: That's, and these course are on the inpatient side.
• 6:07
  Speaker 2: Then you have, for example, there's a huge pharmacy influence in, let's say, pharmacy benefit management.
• 6:18
  Speaker 2: So all the health insurance there's a pharmacy component, as we all know, and so there's avenues down that line as well.
• 6:26
  Speaker 2: So I mean, it's just very, I would say like, pharmacy is very multifaceted and it's not just, let's say, the dispensing component maybe, that the general public is really used to.
• 6:37
  Speaker 2: As far as in the hospital, I mean, we do all sorts of consulting with the physician teams, with the health care teams, and yeah, we're just, I think we're a highly overlooked resource that perhaps the general public does not realize.
• 6:57
  Speaker 2: I think the health care industry and you know they understand our roles, but I think trying to explain more of what we do to the general public probably needs more.
• 7:11
  Speaker 1: Yeah, very good.
• 7:12
  Speaker 1: When I first started this podcast, my very first guest was Ed Hiscock from Trinity Health in Livonia, michigan, and I asked him is the health healthcare supply chain a real supply chain?
• 7:28
  Speaker 1: And he says Fred, in the healthcare supply chain there are many supply chains.
• 7:31
  Speaker 1: There's a medical surgical supply chain, there's a facility supply chain, there's a food service supply chain and there's a linen supply chain.
• 7:40
  Speaker 1: He said and there's linen supply chain.
• 7:43
  Speaker 1: He said, and there's pharmacy supply chain.
• 7:47
  Speaker 1: So what are some of the biggest challenges that pharmacies face in managing the supply chain, especially in terms of medication procurement and inventory management?
• 7:59
  Speaker 1: And how is that different from just kicking boxes in the regular supply chain?
• 8:03
  Speaker 2: Yeah, so ours is definitely unique.
• 8:05
  Speaker 2: It's a behemoth, it's definitely a challenge.
• 8:10
  Speaker 2: So we are governed by so, for example, your contracts we're governed by shortages.
• 8:17
  Speaker 2: That's a huge thing what's available, and so our supply chain is definitely very complex.
• 8:24
  Speaker 2: I would say that within recent years, the shortage issue has been very, very, very big.
• 8:32
  Speaker 2: It's really affecting how you know, it's affecting the general public.
• 8:37
  Speaker 2: I know that a couple years back, and I think even now, some of the ADHD medications went on shortage and so people were really scrambling to try to find that, and so you can see how it affects the patients.
• 8:48
  Speaker 2: At the end of the day, within the healthcare system, we'll have shortages on very common drugs that you would think you really shouldn't have a shortage on, like really common, let's say, nausea drugs or really common pain medications, and so that's really changing how what physicians are prescribing and it's really being agile to whenever these shortages come up.
• 9:13
  Speaker 2: A couple years ago, I think, something went down in some of the manufacturing plants for NS, for sodium chloride you know, like your giant bags that you're getting in the hospital, and that was a shortage.
• 9:27
  Speaker 2: So it's really I mean it's certainly very inconvenient when you're dealing with the shortages.
• 9:34
  Speaker 2: I would say.
• 9:35
  Speaker 2: Another challenge that we have is, especially if you're looking in the hospital system, you have a lot of the times the medications are not all centrally located.
• 9:45
  Speaker 2: And you have a lot of the times the medications are not all centrally located.
• 10:02
  Speaker 2: You know they're not centrally located drug X.
• 10:03
  Speaker 2: And you look in your pharmacy and you're like I don't have any drug X, and so then you go on the.
• 10:08
  Speaker 2: It sets a train reaction of okay, now I have to go order drug X.
• 10:12
  Speaker 2: Then you know all this type of stuff.
• 10:13
  Speaker 2: But then what you may not realize is like oh hey, drug X is actually hanging out in this cabinet up on seventh floor, somewhere that you forgot about, you know.
• 10:22
  Speaker 2: So it's very so we have that.
• 10:23
  Speaker 2: We have that problem too.
• 10:25
  Speaker 2: There's a lot of moving parts and kind of remembering where you have your medications, and so with that comes the, comes that optimization of inventory where it's like okay, you need a drug X, does drug X make sense to be on seventh floor, like the seventh floor use drug X, right?
• 10:44
  Speaker 2: So it's really about balancing that.
• 10:47
  Speaker 2: And then, finally, I think something that perhaps is not the most unique to pharmacy supply chain within healthcare, but we definitely deal with all of our supply has expiration on it and some of the expiration is very high or very, very fast, you know, a lot faster than maybe what you predicted.
• 11:06
  Speaker 2: So you know, ideally it's nice to get medications, let's say like with an expiration date two years out, like that would be great two, three years out.
• 11:14
  Speaker 2: But depending on your contracts, uh, you might be getting short dated medications and so with that, now you have the pressure to really use those medications as soon as possible, otherwise they become expired and as guardians of medication, you know we can't let patients use expired meds.
• 11:31
  Speaker 2: Of course it's a safe, controlled environment.
• 11:33
  Speaker 2: So it's really about balancing all of those types of things to make sure that, to make sure that you're using as quickly as you're buying.
• 11:45
  Speaker 2: So it's these types of balances that I think make pharmacy supply chain a bit more unique.
• 11:52
  Speaker 1: Yeah, you said something at the beginning about manufacturing for normal sailing Back in the Hurricane Maria time a few years back in Puerto Rico, puerto Rico made all the mini bags in the world, so treatment protocols for mini drop bags had to be changed to different protocols.
• 12:16
  Speaker 1: So when you're in the pharmacy and you encounter a crisis and you figure out a way to come up with an alternative protocol, do you maintain uh, do you maintain lists of those alternative protocols so that the next time something comes around, you already know what to do?
• 12:35
  Speaker 2: yes.
• 12:36
  Speaker 2: So I mean, in talking about that, the mini bag situation.
• 12:39
  Speaker 2: That's a great, that's a great example.
• 12:41
  Speaker 2: So the whole thing about mini bags is that the good thing is so number one, the mini bags went on shortage but the NS, let's say, 100 mLs or the NS 50 mLs were still available.
• 12:53
  Speaker 2: So what does that mean for, let's say, a hospital pharmacy?
• 12:57
  Speaker 2: What happens is the whole convenience of mini bags is that you can essentially prepare in a closed system, relatively sterile, especially if you're using it immediately and you don't have to get into, let's say, the IV room to you know, draw up your medication on one end, put it in the syringe and then push it into the NS-100 bag.
• 13:20
  Speaker 2: So that was the whole convenience of mini bags.
• 13:22
  Speaker 2: So your hospital operation in the pharmacy, let's say, you make, let's say, let's say originally, let's say I don't know, maybe 30% of your medications were done through these mini bags.
• 13:34
  Speaker 2: What that means is that you're taking 30% of the workload off of, let's say, your pharmacy technician that's in that IV room, right?
• 13:42
  Speaker 2: And now suddenly you don't have those mini bags.
• 13:44
  Speaker 2: It's like now you just added an extra 30% onto those pharmacy technicians in the IV room because now they have to make it.
• 13:51
  Speaker 2: You don't have that convenience of this closed system thing anymore.
• 13:55
  Speaker 2: So it really changed.
• 13:57
  Speaker 2: Like that, just something very small like that can really shift pharmacy operations.
• 14:02
  Speaker 2: So let's say, before you only had one IV technician.
• 14:06
  Speaker 2: Now, because you don't have any mini bags, it's like now we have to make.
• 14:09
  Speaker 2: Maybe now you have two IV technicians because they just they can't handle that workload because you had the mini bags taking care of it for you.
• 14:16
  Speaker 2: So I mean, even when you're changing protocols or even when you're changing your policies, it kind of has like a domino effect.
• 14:24
  Speaker 2: It could really affect staffing, it could really affect I mean it can affect even the medications that you're buying.
• 14:32
  Speaker 2: So like, for example, mini bags, you it's a one-on-one, so it's like one mini bag plus one vial of drug and you pop them both together.
• 14:39
  Speaker 2: So I mean now let's say you don't have the mini bags anymore.
• 14:43
  Speaker 2: I mean if your pharmacy technician has to make I don't know, maybe like 100 doses of that, that may be buying one vial.
• 14:50
  Speaker 2: That's like 101 vials doesn't make any sense anymore, right?
• 14:55
  Speaker 2: Because now they have to batch making it all.
• 14:57
  Speaker 2: So now you might go to buying a bulk bottle, like you know.
• 15:02
  Speaker 2: Like one bottle, let's say, has 10, has 10, 15, 20 doses in there, and so you're really like, I mean, you can see how it can shift your buying habits, you can see how it's going to shift your operation models, and that's just one shortage.
• 15:14
  Speaker 2: So, um, I will tell you this I went through the mini bag shortage and it was not pleasant to go through.
• 15:24
  Speaker 1: I believe it.
• 15:25
  Speaker 1: I believe it Sort of.
• 15:26
  Speaker 1: You know, piggybacking.
• 15:28
  Speaker 1: That's terrible, that's a bad joke, isn't it Piggybacking onto that.
• 15:33
  Speaker 1: How has the COVID-19 pandemic impacted the operations and supply chain logistics of the pharmacies, and are there any lasting changes or improvements that have been implemented as a result?
• 15:45
  Speaker 2: Yeah.
• 15:45
  Speaker 2: So COVID was definitely a unique time for all of us in healthcare.
• 15:49
  Speaker 2: I think that right now, post-covid, we as an industry kind of have a knee-jerk reaction of hoarding, and I don't think we used to do that as much prior to COVID.
• 16:10
  Speaker 2: I think that COVID really is making us perhaps buy more inventory than just to be on the safe side, you know, like right now.
• 16:13
  Speaker 2: So I don't know if that's necessarily the best thing, because when you start hoarding medication like that, if you don't use it fast enough, inevitably it's going to expire and then it's just going to get trashed.
• 16:24
  Speaker 2: So I understand why perhaps we are going in that direction, but I don't know necessarily that that's the most best use of resources.
• 16:36
  Speaker 2: So I think definitely COVID has prompted that behavior for sure.
• 16:41
  Speaker 2: I think to make it a bit more acceptable, I will say, though, with COVID it's made our.
• 16:49
  Speaker 2: We talked about policies earlier, about how you know, perhaps we implement policies to deal with some shortages.
• 16:55
  Speaker 2: I will say, post-covid, I think that us as an industry has gotten better at perhaps putting policies out that are more easy to adapt and maybe, instead of being reactionary to it, maybe being proactive to potential shortages.
• 17:14
  Speaker 2: So, for example, right now, let's say it's an issue between.
• 17:17
  Speaker 2: We go through this sometimes where it's an issue between morphine and maybe a morphine equivalent, so Dilaudid would be the other one.
• 17:28
  Speaker 2: So I think in the past, let's say, your morphine runs out, well, your pharmacy team sometimes they scramble for a little bit to try to get policies in place where it's like okay, like your physician writes for morphine, pharmacy will automatically substitute it to Dilaudid.
• 17:38
  Speaker 2: And I think in the past it was very reactionary.
• 17:40
  Speaker 2: Like your physician writes for morphine, pharmacy will automatically substitute it to dilaudid.
• 17:44
  Speaker 2: And I think in the past it was very reactionary.
• 17:47
  Speaker 2: It's like we would wait till the morphine, uh, was on shortage and then we would kind of implement that policy in place.
• 17:54
  Speaker 2: And you know, when you implement policies in place in institutions sometimes it takes a little bit of time.
• 17:58
  Speaker 2: Um, it's definitely not overnight instantaneous.
• 18:01
  Speaker 2: I think after covid it's turned into much more of a.
• 18:04
  Speaker 2: I think now there's like a preface which is like, basically, if a physician enters morphine on their side when they're ordering it, it might say like, hey, yeah, we know that you're ordering morphine, but just realize, in case morphine's on shortage, pharmacy will automatically substitute it over to Dilaudid.
• 18:21
  Speaker 2: So it's like policies like that, that kind of these blanket policies that help cover some of these shortages and do it, and the turnaround time is a lot faster.
• 18:30
  Speaker 2: So it's not like we have to, you know, wait for an entire committee to approve it because it's already approved.
• 18:35
  Speaker 2: So I think that COVID's made us faster, a bit more agile, in dealing with some of these challenges that we face.
• 18:44
  Speaker 2: And then, finally, I think that covid has kind of woken up a lot of health care systems to make them realize like, hey, maybe I want a better control of my distribution system, not even just in pharmacy, like in terms of medications, but just materials in general, you, you know, for hospitals.
• 19:06
  Speaker 2: I think it made perhaps some people realize, like you know, like right now we it's very in time, like in time delivery, right.
• 19:15
  Speaker 2: Like you, you need something, you order it from your distributor.
• 19:18
  Speaker 2: It comes the next day, and when we were during COVID you didn't have that same type of luxury.
• 19:24
  Speaker 2: And so I think it's making some of these health systems realize like, okay, well, what if we kind of become our own distributor in a way?
• 19:32
  Speaker 2: Like what if we have better control of our inventory and our supplies so that we can manage some of these shortages better and also just get better price, like you know.
• 19:44
  Speaker 2: Get better buying power, get better pricing and all this other stuff.
• 19:48
  Speaker 2: So I think I think COVID I mean, if we were thinking about some of those things prior to COVID, I think after COVID it definitely made a case to go in that direction.
• 20:00
  Speaker 1: Yeah, that makes sense.
• 20:00
  Speaker 1: Hey, you know, this thought came up while you're talking about this.
• 20:03
  Speaker 1: That makes sense.
• 20:04
  Speaker 1: Hey, you know, this thought came up while you're talking about this.
• 20:06
  Speaker 1: Ed, do you have protocols for generics?
• 20:08
  Speaker 1: So if I use I'm an old guy I use Flomax, okay, and the generic is Tamsulosin.
• 20:14
  Speaker 2: So if the doctor prescribes Flomax, which is a brand name, does the pharmacy automatically have a protocol to go to the generic or do they have to get the permission of the doctor to go to a generic?
• 20:35
  Speaker 2: Yes, so in your example about the Flomax and Tamsulosin, so it is understood that when a physician writes a prescription for Flomax pharmacy, regardless of what pharmacy you go to, they will automatically substitute it to your generic equivalent, which would be the Tamsulosin.
• 20:46
  Speaker 2: Your physician, if he writes on the prescription, do not substitute, like brand only.
• 20:54
  Speaker 2: That would basically be an exception.
• 20:57
  Speaker 2: And so when your pharmacy receives that prescription, they see like, oh like, for whatever reason, the physician wants brand only, and only in those instances we would not substitute.
• 21:10
  Speaker 2: I think that it being controlled also by the, you know, I wouldn't say like a hundred percent control, but I would say the majority of prescriptions, if they're being filled through your prescription, benefits your health insurance.
• 21:26
  Speaker 2: I know that they definitely prefer generics.
• 21:30
  Speaker 2: There are some, I think, flow charts on their end where they would prefer the brand because they get better pricing for it.
• 21:43
  Speaker 2: So there, there's some exceptions of course, along the way, but just in general, um, I think generics are tend to be preferred and so, um, because of that, what ends up happening is, let's say you want the brand.
• 21:55
  Speaker 2: Well, we can make that happen when the pharmacy runs the prescription through your prescription benefits.
• 22:01
  Speaker 2: Let's say, the generic costs $3.
• 22:04
  Speaker 2: Now suddenly you want brand.
• 22:05
  Speaker 2: Yeah, they can make that happen.
• 22:07
  Speaker 2: Now the brand.
• 22:07
  Speaker 2: But you know it's not.
• 22:09
  Speaker 2: the brand is not covered by your insurance and so now you're suddenly, you're going to be paying, let's say, a hundred $200 for the for that application.
• 22:16
  Speaker 1: So true, so true.
• 22:17
  Speaker 1: Switching gears here.
• 22:20
  Speaker 1: What would you like to see in terms of future technology, either applied or developed for?
• 22:28
  Speaker 2: Yeah.
• 22:28
  Speaker 2: So I think that this is definitely an area where I hope to see perhaps more development.
• 22:35
  Speaker 2: I think that in supply chain and just the general supply chain logistics, there's a lot of technologies that are being used that I don't think we get to use either in pharmacy or healthcare, or maybe it's used less or healthcare or maybe it's used less.
• 22:49
  Speaker 2: So, for example, something as simple as the RFID technology, that's something that is, I would say, an empty hole in what's going on in a pharmacy inventory.
• 23:01
  Speaker 2: We do use it.
• 23:03
  Speaker 2: I mean, we definitely use RFIDs, like when we compound medications, we're doing a lot of barcode scanning.
• 23:15
  Speaker 2: I think that's more of a quality control situation where it's like oh, the label says this medication, I scanned this medication because I dispensed it to Fred, and so we have like that quality control check to make sure that either the pharmacist or the pharmacy technician scanned this medication.
• 23:30
  Speaker 2: So I mean, but that's in terms of dispensing.
• 23:34
  Speaker 2: I would like to see more RFID technology in terms of pharmacy inventory, like in the same way that you can go to Home Depot, right, and you can ask like hey, how many of this do you have on your shelf?
• 23:49
  Speaker 2: And the Home Depot associate can pull out with his little barcode scanner, thingy-ma-jig, and it'll tell you, like you know, they have like a number on their shelf where they're like yeah, we have five.
• 24:02
  Speaker 2: And then you guys go to the shelf and you're like yeah, I see about five, you know, sometimes it's like plus or minus, but for the most part it's relatively accurate, right, I would say most hospital pharmacies do not have that Like we don't have.
• 24:15
  Speaker 2: You don't?
• 24:16
  Speaker 2: You can't ask a pharmacy employee to be like how much of drug X do you have on your shelf?
• 24:22
  Speaker 2: Because a lot of times we don't, we don't have that.
• 24:25
  Speaker 2: You'd have to go to the shelf to like physically, look, you don't have like a central database where you can find that information.
• 24:31
  Speaker 2: So that's what I mean by perhaps RFID technology to like really help us with, I think, tracking how much inventory we have, because I think it would help having that information, let's say that data, in a computer database and then when you go to order medications, you can tie that information over to how much you're ordering.
• 24:53
  Speaker 2: I think what's happening is, when we're looking at that process from an individual hospital, like just your one hospital, it doesn't make a lot of sense to do that, because you're thinking to yourself.
• 25:05
  Speaker 2: You're like well, I don't need to go into a computer to figure out that I have five bottles of this drug, because I can walk two steps and look behind me and see that I got five bottles on this drug.
• 25:12
  Speaker 2: Because I can walk two steps and look behind me and see that I got five bottles on the shelf, like correct.
• 25:16
  Speaker 2: I agree.
• 25:16
  Speaker 2: I agree with that argument.
• 25:18
  Speaker 2: However, when you're looking at really large systems of scale, like if you're going to try to do this type of central, if you're going to try to manage as a hospital, as a hospital system, if you're going to try to manage your inventory in a centralized way, then that barcode makes a lot more sense, because now you have it in a database where, oh okay, hospital A, we see they have five, and hospital B, it seems like they need some because they have zero and we can see that from a centralized system.
• 25:51
  Speaker 2: So perhaps, instead of ordering from our drug distributor, how about let's move some from hospital A to hospital B, so you can see the value of having that type, and I think in the healthcare sector that would be really helpful would be wouldn't it be nice to your that your meal is being made right now, but or it's being prepared by the restaurant, or that the meal has been picked up by your uber driver, or that it's on the way to being delivered, or now that it's been delivered, like wouldn't it be nice to know where exactly in this little plan like your medication is?
• 26:48
  Speaker 2: I think for us as just the general public, if your prescription was.
• 26:54
  Speaker 2: Let's say, you dropped off a prescription two days ago and you go two days later expecting to pick it up and you show up at the pharmacy and they're like, oh, it's been stuck because the health insurance you needed a prior authorization for it.
• 27:07
  Speaker 2: Like wouldn't that be nice to know, like way ahead of time before you showed up?
• 27:12
  Speaker 2: But we don't really have like those mechanisms in pharmacy where you can, where you know exactly what the holdup is.
• 27:20
  Speaker 2: And in the hospital system that happens all the time too where, let's say, a nurse or a physician, they're requesting a medication and, you know, maybe your queue is very, very, very long, maybe it's still stuck in the queue, or maybe it's stuck in the filling queue, or maybe the IV technicians in the middle of making it.
• 27:39
  Speaker 2: We get phone calls a lot of the times about, hey, where's the medication?
• 27:42
  Speaker 2: And you're constantly doing these processes over and over again.
• 27:45
  Speaker 2: So it'd be really nice to have that same kind of like pizza making technology to apply it to the pharmacy where you know exactly where it is, because I would say a lot of our um, a lot of our tasks are really tracking down that medication and trying to figure out where it went to sure, sure, let's.
• 28:06
  Speaker 1: Let's have another follow-up technology question here, sure?
• 28:09
  Speaker 1: Um?
• 28:09
  Speaker 1: You other day last, about two weeks ago I think it was you did a presentation at our healthcare group weekly meeting on artificial intelligence and it was excellent.
• 28:22
  Speaker 1: What I liked about it was Albert Einstein once said that if you, if you really understand something, said if I should be able to explain physics to a barmaid, and with the idea being that you can take something that's really complicated but if you understand it well enough, you can deliver messages to folks that they can understand and make relevant, and I thought you did a wonderful job of doing that about AI.
• 28:49
  Speaker 1: But with AI being the phrase of the month in healthcare and every place else, by the way, how do you feel about AI in the pharmacy space and either operational or clinical capacity?
• 29:02
  Speaker 2: Yeah.
• 29:04
  Speaker 2: So I did attend the AI summit by ASHP and it was a great conference to go to up in Portland and AI was definitely a trending topic and I think a lot of the discussion was for sure about how AI can impact healthcare from the clinical standpoint of view.
• 29:24
  Speaker 2: So, for example, let's say, in diagnostics or in helping guide diagnostics or in helping guide, I think, clinical decisions.
• 29:33
  Speaker 2: So that was very, very, very interesting.
• 29:42
  Speaker 2: I think when I was sitting at that conference I was really thinking about how AI can be used just operationally in pharmacy.
• 29:46
  Speaker 2: I think that I mean, like just off the top of my head, I would say it might be.
• 29:53
  Speaker 2: It would be great to, for example, have AI do predictive forecasting, let's say for staffing, like for the hospital system as a whole tail sector.
• 30:12
  Speaker 2: If it could predict the amount of prescriptions that you're going to be filling every single day, that would be great because it has it's going to affect your staffing.
• 30:18
  Speaker 2: Like you know, there's some times where, let's say, you can staff less and then there's some times where you know like, oh, this is going to be a busy season, we're going to need to staff more.
• 30:26
  Speaker 2: I think hospitals in general, for example, I think we kind of already do that.
• 30:30
  Speaker 2: Obviously, in the winter, you know we can expect like, oh, flu season's coming, or you know we have like general predictive I think, common sense about perhaps when the busy seasons are or when the less busy seasons are.
• 30:44
  Speaker 2: However, I don't think that we have as much accuracy with the day-to-day you know.
• 30:51
  Speaker 2: So that would be really nice, I think.
• 30:54
  Speaker 2: On the inventory management side, I see a lot of potential for AI there that I don't think has really have been explored.
• 31:03
  Speaker 2: So, for example, wouldn't it be great if AI could predict your shortages before they even happened, if they just took historic data, if they could also predict your spending, your buying habits, but then not only just the buying habits, but being able to predict.
• 31:25
  Speaker 2: Okay, you bought this amount of drugs.
• 31:29
  Speaker 2: You know you bought like a whole pallet of drugs, and I think what we do right now is we know that we bought a pallet of drugs last year and we know that this year we're going to also buy.
• 31:38
  Speaker 2: Maybe, like you know, you can, you can, you can estimate based off of that.
• 31:41
  Speaker 2: However, you may not be taking into consideration all of the drugs that you wasted because you never used it, and so, with AI, it would be nice to have both of that information for it to make an even more accurate recommendation of how much you should really buy, without you having to feel like, ooh, I don't have enough.
• 32:02
  Speaker 2: You know like.
• 32:03
  Speaker 2: I mean like anyone can order a palette and then say like next year, hey, we'll just buy half a palette.
• 32:07
  Speaker 2: You know Like.
• 32:08
  Speaker 2: But I think, I think it's just like.
• 32:09
  Speaker 2: When you buy that half a palette, I think our natural instinct is like, oh my gosh, are we going to have enough or are we going to be able to get through the busy season?
• 32:18
  Speaker 2: What if, suddenly, we suddenly have this surge of people who suddenly need to use this drug and now we don't have enough?
• 32:23
  Speaker 2: So AI would be great in helping us make better decisions about that.
• 32:30
  Speaker 2: Like, yes, you can be fine with half a palette and based on all this historical data, and let's say, you even take into consideration, okay, if you have shortage of this, that's going to force you to use an alternative.
• 32:45
  Speaker 2: That Is that going to affect, let's say, your palette of this.
• 32:48
  Speaker 2: We kind of have, I think, um opportunities there.
• 32:53
  Speaker 2: So I really think that ai would be very helpful and in those types of applications, um, other than, of course, on the clinical setting, where I think that's that's like, that's that's like so much potential.
• 33:10
  Speaker 2: I think on the clinical setting, like, for example, for example, obviously they're already making some headway in diagnostics, for example, like in radiology and dermatology, using AI to help with imaging of things.
• 33:23
  Speaker 2: I think that AI on the patient interface side.
• 33:29
  Speaker 2: So I think in the future, just us as patients, I think that there's definitely going to be more utilization of chatbot equivalents and I think the chatbots are going to get better.
• 33:39
  Speaker 2: I think they're not going to be so robotic.
• 33:42
  Speaker 2: I think that they're going to have much more of a human element to them.
• 33:47
  Speaker 2: I think they're going to be better at understanding what we mean.
• 33:50
  Speaker 2: So there's that.
• 33:53
  Speaker 2: There's the patient education component.
• 33:55
  Speaker 2: I think, for example, even if you think in the lines of I think for pharmacy, let's say, newly diagnosed diabetics, or let's say you're on anticoagulant medication, I think having AI on that patient education side.
• 34:11
  Speaker 2: So, for example, how do I use an insulin pen or how do I inject myself?
• 34:16
  Speaker 2: You know, sometimes some of those conversations can be long, especially for new, like you know, newly diagnosed people who have never given themselves a shot.
• 34:25
  Speaker 2: And you know, as you know, just because you do it once, or just because someone tells you one time does not mean that you're going to be able to confidently do it yourself.
• 34:35
  Speaker 2: And so I think AI would be really great in, let's say, reinforcing some of those educational principles.
• 34:41
  Speaker 2: I think that would be very helpful.
• 34:45
  Speaker 2: I think that the big question right now with AI is very how predictive and how accurate are the predictions on the clinical sides?
• 34:54
  Speaker 2: So, for example, if you have patients who come in and AI sees all of your markers and your vitals and maybe your patient history and all of this other stuff, and it's able to spit out a number and say, let's say, your outcomes, how good do they look?
• 35:12
  Speaker 2: I think that that's definitely the big controversial area right now, because I think, as clinicians, we like see the potential of it, and I think the big fear is, of course, that accuracy.
• 35:25
  Speaker 2: And then, of course, also the big fear is well, what am I going to do with that information?
• 35:29
  Speaker 2: Like you have patients that come in and maybe their mortality doesn't look so hot, like, does that mean that we're not going to do everything we can to help these patients out?
• 35:39
  Speaker 2: You know, like I think there's a lot of questions still, but for sure, question marks on the clinical side.
• 35:46
  Speaker 2: But I think in the meantime, until we can sort some of those ethical things out on the clinical side, I think on the operational side I think that healthcare systems should really look into adopting AI for that and seeing how I think it could really help their bottom lines.
• 36:05
  Speaker 1: Honestly, I think the ability to augment the human component, though, is really important.
• 36:13
  Speaker 1: I mean the patient education and things like that, and when I first started to learn about AI, the term that really caught my attention was the term hallucination, and I don't think we have enough time to go into that, but basically it means that sometimes AI gets so into itself that it hallucinates and says things that ain't true Correct.
• 36:39
  Speaker 1: Is that fair enough?
• 36:40
  Speaker 1: So last question what trends or innovations do you see shaping the future of pharmacies, and how can healthcare systems prepare for these changes?
• 36:49
  Speaker 2: Sure.
• 36:49
  Speaker 2: So talked about AI before.
• 36:52
  Speaker 2: So I think that that's definitely going to be you're going to have impact of some type of technology.
• 36:57
  Speaker 2: I think scaling up on technology I think is going to be a future trend.
• 37:02
  Speaker 2: I think that as our healthcare systems just become more complex, as you're dealing with more of, let's say, like this last mile delivery, whether it's in that retail space or in, let's say, a hospital, like a healthcare system, let's say you're doing medication delivery to the patient's home.
• 37:21
  Speaker 2: I think that, like, ultimately, we're going to have to scale up on some of that technology.
• 37:31
  Speaker 2: I think that what we had spoken out about before, where healthcare systems are perhaps managing their own distribution models I think you're going to see more of that, because I think they're realizing that they can really leverage their scale and in leveraging that scale, perhaps they can be more efficient, perhaps they can cut costs.
• 37:53
  Speaker 2: They can be more efficient, perhaps they can cut costs.
• 37:54
  Speaker 2: So I think pharmacy is a natural department to really try to consolidate some of that and I think you're going to see a lot more of this like spoken wheel type of distribution model for healthcare systems, where you know each hospital, let's say it's doing their own little thing, but perhaps off-site somewhere, you have an entire distribution center managed by the healthcare system where they're taking care of all of their own materials management, but on top of that, they're taking care of the pharmacy side.
• 38:23
  Speaker 2: I think that that's going to be very popular in the future because it's definitely less risk-averse.
• 38:30
  Speaker 2: So or I'm sorry more risk averse.
• 38:35
  Speaker 2: So I think that that would be.
• 38:37
  Speaker 2: I think that that's definitely a trend that we're seeing and that more healthcare systems are just naturally going to adopt.
• 38:46
  Speaker 1: Yeah, well, the other thing is that there will.
• 38:50
  Speaker 1: The trend is also that there will be fewer healthcare systems or IDNs, but they'll be larger, so they'll have more capacity and be able to get the resources to take those types of approaches.
• 39:05
  Speaker 1: Yes, yes completely Well, Sharona, it has been a real pleasure having you on the podcast today, and probably in the future we'll have you on more times.
• 39:17
  Speaker 1: You have a wealth of knowledge and you get your points across in ways that even someone as simple-minded as me can understand.
• 39:31
  Speaker 2: No, no, no.
• 39:37
  Speaker 1: Well, thank you so much.
• 39:38
  Speaker 1: No, well, thank you so much.
• 39:39
  Speaker 1: Well, thank you and folks, we'll see you next time on taking the supply chain pulse.
• 39:42
  Speaker 1: Thank you, take care.