When pharmacist Rita K. Jew saw a robot that mixes intravenous drugs at an industry event, she instantly knew she wanted it for her own hospital.
“This is definitely a breakthrough in technology,” says Jew, executive director of pharmacy and nutrition services at in California.
Despite medical and technological advances, most hospital pharmacies still prepare intravenous drug solutions manually. But the founders of medical equipment maker Computerworld Honors program.
* Organization: Intelligent Hospital Systems, a medical device maker based in Winnipeg, Manitoba, designs and develops high-tech automated equipment for hospitals. Its first and only product to date is a system called RIVA — for Robotic IV Automation — which automates the preparation of intravenous solutions in hospital pharmacies.
* Workforce: Intelligent Hospital Systems has about 80 employees.
* Project team: Some 16 computer scientists and computer engineers work on RIVA’s IT components.
* Project ROI: RIVA costs about $1 million, but the company calculates that hospital pharmacies can see a return on investment within two years because RIVA can reduce the amount of medicine wasted in the preparation process and cut the need for costly premixed medications.
“This is an example of how technology is being applied to do something better,” says Roger A. Edwards, an assistant professor in the departments of pharmacy practice and health sciences at Northeastern University in Boston.
The common practice of mixing IV drug compounds by hand is time-consuming and susceptible to mistakes, says Luci A. Power, senior pharmacy consultant at San Francisco-based Power Enterprises, who works with Intelligent Hospital Systems.
“Many errors have resulted from this manual compounding, and much microbial contamination has been documented in this compounding,” she says. “As long as humans compound IV drug therapy, there are problems to contend with. The use of robotics alleviates many of these issues.”
The idea for a pharmacy robot came from a hospital, says Thom Doherty, chief technology officer at Winnipeg, Manitoba-based Intelligent Hospital Systems. Market research confirmed that pharmacists wanted an in-house automated system that could mix IV drug compounds, he says.
Intelligent Hospital Systems was formed in 2004 to develop such a robot, bringing together a team of mechanical, electrical and computer engineers to do the job. Although each discipline was crucial, Doherty acknowledges that “it’s the software that drives all the components.”
Cornel Van Egmond, a senior software developer at Intelligent Hospital Systems, says RIVA’s software has two key parts: a user interface and back-end logic that controls the system.
Van Egmond says that nearly all the software for RIVA was written in-house. The team selected Windows XP as RIVA’s operating system and wrote in C# for the .Net 2.0 platform.
The company used some off-the-shelf hardware, including robotic grippers and programmable logic controllers.
Doherty and Van Egmond say one of the biggest challenges was that pharmacists wanted to be able to continue working with the lab equipment they already used; for example, they didn’t want to switch to proprietary syringes and vials to accommodate the robot.
Therefore, Intelligent Hospital Systems engineers had to design a robot that could handle pieces of equipment that weren’t uniform in size or shape.
Engineers turned to technology to solve that problem, Doherty says. RIVA uses a relational database to hold the data that determines the robot’s movements for handling equipment. The database also stores the processing steps used to prepare the IV products. RIVA uses its database to understand how to accept input products (syringes, IV bags and vials, for example) that are of varying dimensions.
RIVA also uses a relational database to securely store drug order information, confidential patient information and other important data.
The engineers decided to use Sybase Inc.’s SQL Anywhere relational database for those purposes; they determined that it’s well suited to serve as an embedded application because of its low overhead and small footprint.
“It’s basic engineering, but it’s how it came together and integrated all the hardware and all these systems to make them work in concert that’s the real accomplishment,” Van Egmond says.
The resulting self-contained robot is 5 feet wide, 10 feet long and 8 feet tall. RIVA works in a closed environment, thereby reducing human exposure to medicines and protecting both people and drugs from contamination.
RIVA uses sterile air and high-intensity UV light for sterilization, and it has cameras, vision systems and scales to ensure the end products are correct. It creates a detailed audit trail as well.
The robot can prepare between 40 and 60 doses per hour, Doherty says, and it uses its database of information to verify and label the doses it dispenses.
He notes that hospitals that use manual processes will prepare IV drugs once or twice during a 24-hour time frame, and much of the medicine will go to waste as doctors change prescriptions. Some pay a premium to have the solutions prepared by a third party. So even though RIVA sells for about $1 million, Doherty says hospitals can see a return on their investment within 18 to 24 months by reducing the amount of wasted medicine.
Jew says she was sold on RIVA’s automated safeguards. “They really thought through every single step,” she says. “There’s no way for the machine to take shortcuts. I can’t claim the same with human production.”
But she sold her hospital’s executives on RIVA by touting its ability to save money, calculating a two-to-three-year ROI. Jew says the hospital used to waste 20% to 30% of the IV medicine it made, but because of RIVA’s efficiency, which cuts the lag time between when a doctor orders a prescription and when the medicine is used, that figure is now less than 10%.
Children’s Hospital of Orange County was the first to use RIVA; it started delivering IV doses prepared by the robot in December 2008. Doherty says that even though the economy has forced hospitals to cut spending, three RIVAs are in use at hospitals today, and at least 12 more installations are planned for this year and next.