System and method for management of pharmacy workflow

A system and method for optimized management of pharmacy workflow, specifically, workflow associated with fulfillment of prescription orders for medications and health-related products in a pharmacy environment. A computer-controlled system coordinates and controls pharmacy workflow to sequence prescriptions for fulfillment in a most efficient path thereby minimizing a cost function associated with fulfillment of the prescription order. The system coordinates and controls prescription order fulfillment from automated and non-automated storage locations and can be easily adapted to the specific layout and level of automation desired by the operator.

FIELD OF THE INVENTION

The present invention relates to management of workflow in a pharmacy environment. More particularly, the invention relates to a system and method for optimized fulfillment of prescription orders within the pharmacy.

BACKGROUND OF THE INVENTION

Pharmacies are an important source of medications and health-related products for a wide range of people including, for example, retail customers, hospitalized patients and residents of alternate site (e.g., long term care) facilities. The pharmacy which serves the needs of such people may be located for instance, in a retail environment, such as a drugstore, or as a facility adjunct to the hospital or alternate site facility. A typical pharmacy is staffed by at least one registered pharmacist and is further staffed by trained pharmacy technicians and clerks.

Pharmacy personnel provide a broad range of services and information. For example, the pharmacist typically has overall responsibility for ensuring that all prescription orders for medications and health-related products are fulfilled properly. The pharmacy technicians may assist the pharmacist in fulfillment of the prescription orders and in replenishment of the medication inventory. Pharmacists and pharmacy technicians commonly provide other important services such as interaction with customers, doctors and care givers, the provision of health-related advice, data entry and the processing of medical and financial information adjunct to fulfillment of the prescription orders. Provision of advice and information may include direct interaction with others while data processing and order fulfillment typically involve interaction between the pharmacy personnel and a computer or with the medications and products needed to fulfill the prescription orders. For example, fulfillment of the prescription orders may involve locating one or more medications or products at a static storage shelf or other storage location, dispensing a quantity of the medications or products required to fill each prescription comprising the order, manually packaging the medications in containers (such as bottles and vials) and dispensing the packaged medications and products to the customer, doctor or care giver.

It is highly desirable for the pharmacist and pharmacy technician personnel to be available to provide high value added services, such as providing health-related advice and information to customers, doctors and care givers. It is also desirable to fulfill each prescription order in terms of the lowest possible cost function. Such cost function may be defined in terms of many variables, such as the total time required to fulfill each prescription order, the spacial distance traveled by the pharmacy personnel within the pharmacy in order to fulfill each prescription order and the cost to the pharmacy of the medication and products used to fulfill each prescription order. The cost function may also be defined in terms of cost reduction through coordination of the fulfillment of co-pending prescription orders. A further critical requirement of the pharmacy is the need for accuracy and error avoidance in the fulfillment of the prescription orders.

To these and other ends, there has been a growing use and acceptance of automation in connection with fulfillment of prescription orders by pharmacies. Such automation can include the use of computerized information databases for processing medical and financial information, the use of automated apparatus for dispensing medications and articles and the use of machine-readable code (e.g., bar coding) for purposes of ensuring accuracy in fulfillment of the prescription orders and in maintaining inventory. Any improvement in pharmacy efficiency may result in an overall better level of service to the customer, doctor or care giver.

A major problem confronting the use of automation in the pharmacy environment is the legitimate need for human beings to participate in the prescription order fulfillment process. Pharmacy personnel are required to make many complex decisions and to undertake many tasks to fulfill the prescription orders in an efficient manner. Judgments must be made, for example, as to the medications and products best suited to the customer's needs and the most efficient path by which to locate, obtain, package and dispense the contents of each prescription order, and to do this in a manner which minimizes the potential for error. Moreover, human beings require time to fulfill the prescription orders including the time required to move spatially within the pharmacy from storage location to storage location. In fact, it has been demonstrated that a pharmacy employee may walk as much as five miles throughout the pharmacy during the course of a typical work week; this represents a time component which contributes to the cost function associated with fulfillment of the prescription orders. Consequently, the use of pharmacy automation must coordinate human and machine resources to fulfill each prescription order at the lowest cost function with the highest possible level of error avoidance.

While there are a number of pharmacy automation systems and products described in the art, those systems and products do not disclose systems for optimized management of workflow associated with fulfillment of the prescription orders. For example, U.S. Pat. No. 5,597,995 (Williams et al.) describes a prescription fulfillment system which requires imaging, filling and checking work stations. Medication is dispensed into containers at the filling work station from a collection of automated dispenser apparatus or from static storage locations. While certain efficiencies are derived from use of automated dispenser apparatus, the '995 patent fails to describe any coordinated and optimized use of the system components to select medications with the lowest cost function and fail to disclose any procedure or apparatus to efficiently sequence the prescriptions comprising fulfillment of the prescription orders thereby optimally reducing the cost function associated with the fulfillment process.

U.S. Pat. No. 5,907,493 Moyer et al.) describes a pharmaceutical dispensing system for filling prescriptions in a pharmacy setting. A central computer controls a plurality of pill dispensing cells each of which are stated to include helical singulation apparatus each under the control of a separate microprocessor. Medications may also be stored for dispensing at shelf locations. While the central computer is stated to store information regarding a plurality of drugs in predetermined, separately-addressable cells and to arrange that information to provide optimum efficiency of pharmaceutical operations, such assertion of efficiency does not include any coordinated and optimized use of the system components to select optimized medications for each prescription and then sequence filling of the prescription so as to optimally reduce the cost function associated with the prescription order fulfillment process.

An automated pharmacy is described in U.S. Pat. No. 6,202,923 (Boyer et al.). The pharmacy described therein is said to have improved pharmacy throughput because the labels to be affixed to the medication containers are generated once the the specified prescription is displayed at a filling workstation thereby avoiding any requirement to manually transfer labels from an upstream data entry workstation. Unfortunately, workflow in the automated pharmacy is not fully optimized because, once again, there is no provision for any optimized sequencing of the prescriptions comprising the prescription order to reduce the cost function associated with the prescription order fulfillment process.

U.S. Pat. No. 6,181,979 (Murakami) discusses a drug preparation system. Data are collected to determine the throughput times of particular drug processing and throughput stations within the system. The information is used to allocate pharmacy personnel to the various drug processing and inspection stations but is not utilized to determine an optimum sequence of prescriptions within an order.

It would be significant improvement in the art to provide an improved pharmacy automation system and method of pharmacy workflow management which would optimally reduce the cost function associated with fulfillment of prescription orders, which would reduce the potential for errors in the fulfillment process, which would be operable to control virtually any type of dispensing and storage apparatus, which would be adaptable for use in many different pharmacy environments, including for example, retail pharmacies, alternate site facilities, hospitals and like facilities, and which would free pharmacists and pharmacy technicians to perform high value added services thereby better serving the customers, doctors and care givers reliant on the pharmacy.

OBJECTS OF THE INVENTION

It is an object of the invention to provide an improved pharmacy automation system and method of pharmacy workflow management overcoming some of the problems and shortcomings of the prior art, including those referred to above.

Another object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which would reduce the cost function associated with fulfillment of prescription orders to an extent not capable of being provided by existing pharmacy automation systems.

An object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which is simple to utilize in the pharmacy environment.

Still another object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which would minimize the need for human involvement in the prescription order fulfillment process.

Yet another object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which would reduce the amount of time required to fulfill a prescription order.

It is also an object of the invention to provide an improved pharmacy automation system and method of pharmacy workflow management which would reduce the spacial distance required to be traveled to fulfill a prescription order.

It is an object of the invention to provide an improved pharmacy automation system and method of pharmacy workflow management which reduces the potential for errors in the fulfillment process.

Another object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which is adaptable for use with a range of pharmacy environments.

A further object of the invention is to provide an improved pharmacy automation system and method of pharmacy workflow management which is adaptable for use with any filling or storage apparatus within the pharmacy.

One additional objective of the invention is to free pharmacy personnel for better service to the pharmacy customers, doctors and care givers.

How these and other objects are accomplished will become apparent from the following descriptions and the drawings.

SUMMARY OF THE INVENTION

In general, the invention is a workflow management system (“WMS”) and method for optimized management of pharmacy workflow, specifically, workflow associated with fulfillment of prescription orders for medications and health-related products in a personnel-driven pharmacy operation. (As used herein, the term “medication” is intended to be a broad term including medications as well as health-related products typical of those provided by pharmacies.) Each prescription order fulfilled by the pharmacy includes one or more prescriptions. The medications accessed to fulfill the prescriptions comprising each prescription order may be located at automated and/or non-automated medication storage locations organized into “fulfillment centers” and positioned about the pharmacy.

The WMS coordinates and controls prescription order fulfillment by organizing fulfillment of the prescriptions in the most efficient workflow path and then by directing the pharmacy personnel to and between the fulfillment center automated and/or non-automated medication storage locations to retrieve the required medications, also in the most efficient workflow path. The WMS is intended to make the task of the pharmacy personnel easier and more reliable, thereby providing a higher level of service to the customer. Therefore, the present invention is intended for use in personnel-driven pharmacies where direct human involvement is required to fulfill the prescriptions in the prescription order, and does not relate to fully mechanized and automated facilities, which are outside the scope of the invention.

The invention includes a computer-controlled system of pharmacy management which coordinates fulfillment of each prescription order based on the pharmacy layout and storage location of the medication required to fulfill each prescription within the prescription order. The WMS determines the optimal sequence for fulfillment of each prescription within a prescription order and places the prescriptions within a prescription sequence to minimize the cost function associated with filling the prescription order.

The cost function is established by means of rules which may be developed based on the requirements of the pharmacy operator. Most commonly, those rules will seek to minimize the monetary cost or time required to fill a prescription order. However, other rules may be developed including, for example: (1) rules for reduction of the distance traveled to fulfill a prescription order; (2) rules for reduction of time and distance required to fulfill a prescription order; and (3) rules for reduction of time required to fulfill co-pending prescription orders based on sequenced utilization of the storage locations required for fulfillment of the co-pending prescription orders.

The improvements in efficiency made possible by the invention free valuable pharmacy personnel to perform value added functions such as providing advise and guidance to customers and health care providers. Moreover, the system increases pharmacy throughput and reduces the potential for error further improving pharmacy work flow.

In one embodiment, the WMS for optimized management of workflow associated with fulfillment of medication prescription orders includes a plurality of spaced-apart medication storage locations. Preferably, the storage locations are at fulfillment centers and include automated and/or non-automated dispenser and storage apparatus. However, the precise apparatus selected for the storage locations will be tailored to the needs of the particular pharmacy operator. The system further includes a medication inventory including plural medications stored at predetermined storage locations within the system.

A control computer is provided, preferably as part of a local area network, to receive prescription orders from a host pharmacy information system into a prescription order database. The control computer includes programmed instructions adapted to optimize the pharmacy workflow associated with fulfillment of the prescription orders including instructions for management of the medication inventory database and prescription order data base and to minimize the cost function associated with fulfillment of the prescription orders stored in the prescription order database. The programmed instructions enable: (1) for each prescription within the prescription order, selection of the medication storage location from which to obtain the medication required to fulfill the prescription; and (2) for each prescription order, determination of a prescription sequence corresponding to the sequence in which each prescription is fulfilled, first to last, within the prescription order.

Once the sequence is determined, the control computer utilizes programmed instructions to permit the system to present in human-readable form (for each prescription order), the prescription sequence and the storage location of the medication comprising each sequenced prescription, and generate a print_label command following obtaining of each sequenced prescription. The print_label command is received by a label printer electronically connected to the control computer causing the label printer to print a label including prescription information and machine-readable indicia for each sequenced prescription. The label is of a type adapted for application to a container for each prescription within the prescription order.

The prescription sequence may be visually presented on a display device located at a work station in the pharmacy. More than one work station may be provided. An input device at the work station permits the pharmacist or filling technician to select each of the sequenced prescriptions for fulfillment. Preferably, the prescription sequence presented includes, for each sequenced prescription: text information; medication image information; and an icon representing each storage location corresponding to the sequenced prescription.

Preferably, a sequence sheet is provided as an aid to the pharmacy personnel in fulfilling the prescription order. The prescription sequence is printed at the pharmacy and includes the prescription sequence printed thereon including the machine-readable indicia for each sequenced prescription. The sequence sheet may then be manually carried to each storage location as directed by the prescription sequence.

Preferably, the print_label command used to initiate printing of the label is generated in response to agreement between an initiate_dispense signal and a medication_dispensed signal. The initiate_dispense signal is triggered by an input device, such as a touch screen display, bar code scanner, mouse or keyboard, before obtaining each prescription in the order. The medication_dispensed signal is generated during or after obtaining each prescription in the order, for example by the automated dispenser or by manually scanning a bar code on the package containing the medication.

It is very highly preferred that at least one of the WMS work stations includes a computer for validation of the prescription order before release to a customer. The computer is electronically connected to the control computer and the input device for that computer includes, at least, a reader device electronically connected to the workstation computer. The preprogrammed instructions for validating each prescription order at the work station include instructions adapted to: (1) receive a first validation signal generated by selecting, with the input device, a prescription from the prescription sequence presented on the display device; (2) receive a second validation signal generated by reading, with the reader device, the machine-readable indicia on the label applied to the container corresponding to each selected prescription; (3) determine agreement between the first and second validation signals; and (4) release the prescription order after agreement for each prescription is determined.

The invention may include a replenishment process managed by the WMS.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The pharmacy workflow management system1(“WMS”) of the invention will first be described with respect to the exemplary pharmacy layouts illustrated inFIGS. 1-4.FIG. 1represents the layout of a conventional pharmacy3whileFIGS. 2-3illustrate the layout of an improved pharmacy5according to the invention, including automated and non-automated (i.e., manual) dispensing apparatus as described in detail below.FIG. 4shows a further improved pharmacy7according to the invention provided to demonstrate that the invention is highly adaptable for use with a variety of automated and non-automated dispenser apparatus. Each pharmacy5,7shown inFIGS. 2-4can be located in any environment wherein medications and products are dispensed in order to fill prescription orders and wherein direct human intervention in the order-filling process is required. Thus, the term “pharmacy” is intended to include diverse environments including retail pharmacies, pharmacies in alternate site facilities, hospital pharmacies and the like.

Referring now toFIG. 1, the conventional pharmacy3shown therein includes an order entry workstation9, a filling/checking workstation11, a payment workstation13and a consultation workstation15. Conventional pharmacy3is provided with any number of non-automated storage locations at which medications and products are stored for access by pharmacy personnel. For example, the pharmacy3shown inFIG. 1is provided with an array of six static storage shelf units17. Each storage shelf unit within the array17is typically about 6 to 8 feet in height and includes a plurality of spaced-apart horizontally-oriented shelves. Medications and products are stored on each shelf within the array17pending manual retrieval for fulfillment of a prescription order.

Pharmacy3may include other storage locations such as a restricted-access cabinet19for storage of narcotics and other controlled medications. Pharmacy3may also include a refrigerator21for storage of perishable medications and articles.

Pharmacy3is staffed by personnel having varying levels of responsibility. The pharmacy staff includes at least one registered pharmacist23,25. Each pharmacist (e.g., pharmacist23) is responsible for fulfillment of prescription orders and for verification of each prescription order before the order is provided to a customer27-35. One or more filling technicians37,39may be employed to assist pharmacists23,25in fulfilling each prescription order. The pharmacists23,25or filling technicians37,39may also provide health-care-related information to a customer31at consultation station15.

A data entry clerk41is provided to supply prescription order information to a host computer and pharmacy information system (not shown) via computer terminal43or45at data entry station9. A sales clerk47processes sales transaction at the payment workstation13using computer terminal14or16.

Workflow at conventional pharmacy3may be summarized in the following manner. Data entry clerk41may input the prescription order information to the system at data entry workstation9using keyboard49or computer mouse51of computer43. Following adjudication by the pharmacy information system, each adjudicated order is held in a database on pharmacy computer53at filling/checking workstation11for fulfillment, typically on a first in first out (“FIFO”) basis. Labels for attachment to each container associated with the prescription order may be printed on printer55.

Pharmacist23,25or filling technician37,39selects the prescription order next in line to be filled. The prescription order, and prescriptions comprising the order, may be displayed on video display57associated with computer53. The prescriptions making up the prescription orders are not arranged in any particular sequence.

The pharmacist23,25or filling technician37,39then fills each prescription in the prescription order. Each prescription in the prescription order is filled by walking to one of the storage locations17-21and retrieving the appropriate medication which may be in bulk-form or in prepackaged form. The medication is then taken from the storage location17-21to the filling/checking work station11where the appropriate number of medications are metered into a container, such as vial59with reclosable cap61(FIG. 7A), in accordance with the prescription order. The corresponding label is placed on each container (e.g., vial59).

This process is repeated until each prescription in the prescription order is fulfilled. The prescription order is then verified by pharmacist23,25at filling/checking work station11to ensure that the correct medication is in each container (e.g., vial59). The fulfilled order is then placed in a bag or other package and is held at a “will call” area63near payment work station13. Sales clerk47processes the transaction and delivers the packaged prescription order to customer33at the payment work station13.

There are a number of problems associated with conventional pharmacy3shown inFIG. 1and described above. For example, conventional pharmacy3requires excessive amounts of time and spacial travel to access medications stored at the spaced apart storage locations17-21. The pharmacist23,25or filling technician37,39must repetitively walk back and forth between storage locations17-21and filling/checking work station11. In a busy pharmacy3this can amount to many miles of walking during a 40 hour work week. While known automation technology could be added to pharmacy3to facilitate dispensing of medications and products and improve accuracy of fulfillment, there is no process for organizing prescription order work flow so as to direct pharmacy personnel toward fulfillment of the prescription orders according to a minimized cost function. Therefore, there are opportunities for improvement of the pharmacy3.

Referring next toFIGS. 2-5, there are shown pharmacies5,7including the WMS1according to the invention. As will be explained in detail below, pharmacies5,7are configured for improved management of prescription order fulfillment workflow. Pharmacies5,7include many identical components and for purposes of convenience and brevity, identical reference numbers will be utilized to describe and identify these like components. Pharmacy7differs from pharmacy5primarily in that such pharmacy7is intended to fill a greater number of prescription orders per unit time (i.e., has a greater throughput) than the pharmacy5ofFIGS. 2-3.

It should be understood that the pharmacies5,7are exemplary. A pharmacy according to the invention may be scaled and tailored to meet the demands of the pharmacy operator. Thus, the WMS1may be adapted for use in retail, hospital and alternate site environments and such adaptability is an advantage of the invention.

As shown inFIG. 5, each pharmacy5,7includes a local area network (“LAN”)65which interfaces with a host computer67and pharmacy information system (“PIS”)69and a number of designated areas at which pharmacy activities are carried out.FIG. 5shows an exemplary LAN65for use in one embodiment of the invention. LAN65and its components may be adapted to meet the needs of particular pharmacy operators.

Pharmacies5,7each include: an order entry point71; one or more fulfillment centers73-79associated with medication storage locations as described below; validation point81; and pick-up point83. A technician work center85is provided as a general work area and as the primary area in which fulfillment of prescription orders is initiated. An optional consultation point87where advice and health-related information is provided may also be included as a part of pharmacies5,7. A will-call area89is provided to hold fulfilled prescription orders awaiting pick-up by the customer, health care worker or other designated person.

The novel fulfillment centers73-79will be described first followed by discussion of the interface of centers73-79with LAN65and other elements of pharmacies5,7. The automated and manual storage locations at which medications and products are stored and dispensed are organized into groups referred to herein as fulfillment centers73-79. The number of fulfillment centers73-79and the apparatus associated with each such center may be adapted to meet the unique needs of each pharmacy operator. Pharmacy5includes three fulfillment centers73,75and79. In the example shown, first fulfillment center73is provided to dispense bulk-form medications via semi-automated dispensers91,93,95and97. Bulk-form medications are medications that are in a loose, flowable form suitable for dispensing in any required quantity. Such medications may be provided in many different shapes and sizes and are dispensed into containers such as vials59, bottles105and unit dosage packages108(FIGS. 7A-7D).

Dispensers91,93are preferably FastFill® brand dispensers available from AutoMed Technologies, Inc. of Vernon Hills, Ill. Each FastFill dispenser91,93dispenses from each of 64 bulk-form medication storage cassettes located within the dispenser. Dispensers95,97are preferably QuickFill®Plus and QuickFill® brand dispensers also available from AutoMed Technologies. Dispenser95dispenses from six cassettes while dispenser97dispenses from 1 bulk-form medication storage cassette. All of the cassettes for dispensers91-97are interchangeable.

Cassettes99-103shown inFIGS. 3,3C and7E are exemplary of the type of cassette useful with dispensers91-97. Each cassette99-103is designed to store a single type of medication in bulk form and is designed to fit on a corresponding base located on or within the dispensers91-97.FIG. 3Cshows cassette103mounted for use on QuickFill dispenser97. The medications are metered out from the cassette corresponding to the medication designated for the prescription and into a container, such as vial59or bottle105(with reclosable cap107). Each medication is dispensed into vial59or bottle105positioned in contact with a release gate (not shown) and below the appropriate dispenser spout, such as spout109-113. Contact with the gate triggers the medication_dispensed signal discussed below. Each cassette includes a code, such as a bar code114to facilitate location of each cassette at a storage location.

Each cassette (e.g., cassettes99-103) is associated with a unique medication storage location, either in dispensers91-97or at a storage location, such as shelves115,117,119utilized when the cassettes are not positioned in or on the dispenser91-97. Each storage location, for example shelf locations115-119, has a unique storage location for each cassette (e.g., cassettes99-103) represented by an address code of which codes121,123are representative (FIG. 3D). Codes121,123preferably include a machine-readable code, such as the bar codes122,124shown as part of codes121,123to further identify each unique storage location.

As shown particularly inFIGS. 3 through 3D, fulfillment center73of pharmacy5may optionally include additional work surfaces, shelves and drawers. For example, pharmacy5may include work surfaces125,127and any number of additional storage locations provided to store medications and products useful in conjunction with fulfillment of prescription orders. Overhead shelves129,131may be provided above work surfaces125,127. Large pull-out drawers, such as drawers133,135, pull-out foot drawers, such as drawers137,139and lower tray shelves, such as shelves145,147may be provided beneath work surfaces125,127. Base cabinets141,143supporting dispensers91,93may also include storage locations in the form of drawers, such as drawers146,147. Each of these storage locations has its own address code (not shown) to permit identification of the medications stored in a predetermined manner at the storage locations. If desired, the client computers187-191for fulfillment centers73,75and79could be located in base cabinets141,143.

Referring further toFIGS. 2-3, pharmacy5may also include a further fulfillment center75including pre-packaged form automated product dispenser151. A suitable dispenser151is a QP300 dispenser available from AutoMed Technologies. Pre-packaged form medications or products are products provided in the form of a pre-packed product, such as prepackaged product153shown inFIG. 7Cor the CERTS container stock image318shown inFIG. 27. The prepackaged product holds a pre-determined quantity of a medication or product in a packaged form. Such a prepackaged product could include a wide range of articles and things such as a one-month supply (i.e., 30 units) of a medication, a prepackaged syringe or a packaged roll of gauze bandage. Frequently, there are cost advantages associated with prepackaging of medications into quantities commonly requested by customers such that it may be less expensive to fulfill a prescription order with a prepackaged medication product rather than to perform the dispensing through use of bulk-form medication dispensers at the pharmacy5,7. As discussed herein, WMS1permits selective dispensing between like medications based on the least expensive form of the medication available. The QP300 dispenser stores approximately 300 prepackaged articles at shelf locations within the device. The QP300 dispenses the designated prepackaged product (e.g., prepackaged product153) into a bin155so that the product can be grasped by the pharmacist241or filling technician247Each prepackaged product153includes machine-readable indicia154(FIG. 7C), such as a bar code, and each storage location within the QP300 has a unique address associated with that location. The address may be in any suitable form and may consist of a code (including a machine-readable bar code) such as codes121,122,123,124shown inFIG. 3Dwith respect to shelf115or code183shown inFIGS. 2A,4A.

Referring toFIG. 4, pharmacy7includes a fulfillment center77which incorporates a QuickScript® brand automatic dispenser apparatus159in place of the automatic dispensers91-97and151provided for use in conjunction with pharmacy5. The QuickScript dispenser159is also a product of AutoMed Technologies.

The QuickScript dispenser159has a higher throughput than the dispensers91-97and151and may be configured to dispense both bulk-form medications and prepackaged form medications. The canisters holding bulk-form medications (not shown) and prepackaged articles (e.g., prepackaged product153) are positioned at unique storage shelf locations (not shown) within dispenser159. Each storage shelf location has a unique address associated with it. The bulk-form medications are dispensed from the associated canister and are packaged into containers such as vial59or bottle105while the pre-packaged products (such as product153) are stored in bins or at shelf locations (not shown) within dispenser159. The address of each storage location may be in the form of a code121,122,123,124shown by example inFIG. 3Dwith respect to shelf115or code183shown inFIGS. 2A,4A.

Dispenser159is configured to automatically fulfill each prescription within a prescription order and then accumulate all medications and products pertaining to the prescription order in a single location, such as accumulator bin161. A feature of dispenser159is that it can capture a digital image of the bulk-form medications after they are loaded into the container59,105and before the associated cap61,107is placed onto the container. The image can then be compared to a stock image318of the medication during validation as discussed in detail below. Stock image318is preferably held in a database associated with computer209. Thereafter, the pharmacist or filling technician can collect all packaged medications and articles pertaining to the entire prescription order from the bin161for subsequent validation before being provided to the customer.

Pharmacies5,7optionally include a further fulfillment center79consisting of manually-accessed high density shelf locations163,165. Each shelf location163,165includes a plurality of drawers, of which drawers167,169and171are exemplary. Each drawer (e.g., drawers167-171) is mounted to slide outwardly from shelf locations163,165as shown inFIGS. 2 and 4. Each drawer167-171optionally includes medication storage locations in the form of a plurality of cells, such as cells173,175and177(FIGS. 2A,4A). Each cell173-177is provided to store a medication or product, such as containers179,181(FIGS. 2,2A,4,4A). Each cell173-177has a unique address and may include an identification code183. Code183may also include machine-readable indicia184,186, such as a bar code, to facilitate identification of each storage location.

Fulfillment center79of pharmacies5,7may also include a static shelf unit185for storage of containers for bulk-form articles. Each static shelf unit185may be of any suitable height and includes a plurality of spaced apart horizontally-oriented shelves (not shown). The bulk-form medications or articles may be arranged in any suitable manner within shelf units185. Refrigerator240for storage of perishable medications and articles may be provided at center79. Further, a narcotic-product storage cabinet189may also provide storage locations within center79. The narcotic-product storage cabinet189is locked with access limited to authorized personnel. As with each of the medication storage locations at fulfillment centers73-79, each of the storage locations within shelf unit185, refrigerator240and cabinet189is provided with a unique address which may be designated with a code (including a machine-readable bar code), such as codes121,122,123,124,183,184.

Each fulfillment center73-79is electronically connected to LAN65as shown schematically inFIG. 5. Each interconnecting solid line between the components of LAN65onFIG. 5represents suitable electronic connection between such components. The dashed line connecting fulfillment center77to LAN65represents that center77is shown as part of pharmacy7and not pharmacy5. In addition to one or more automated or manual storage locations, each fulfillment center includes a client computer, respectively designated by reference numbers187,189,191,193. Each client computer187-193is provided with a video display195, and one or more input apparatus such as keyboard196, a machine-readable code scanner197, computer mouse199and touch screen201. Because of the flexibility in configuration offered by LAN65, it is possible that one display195may serve more than one center73-79. For instance, display195at fulfillment center75could also serve as the display for fulfillment center79. Each client computer187-193and associated components195-201at each fulfillment center73-79controls pharmacy workflow at that location. The client computers187-193are linked into the LAN65along with one or more printers, such as sequence sheet printer203and label printers205.

The configuration of the overall system is, of course, dependent on whether the preferred mode of operation is “paperless” or will utilize a sequence sheet269. Both from a perspective of convenience and from increased productivity, a system configured for paperless operation would include a greater number of video displays195positioned conveniently at each fulfillment center about the pharmacy. Other input devices, such as keyboards196, machine-readable code scanners197and computer mice199are provided. For configurations utilizing a sequence sheet269and for reasons of both productivity and convenience in such a configuration, it would be necessary to provide machine-readable code scanners197at each fulfillment center.

The architecture of the computer system responsible for management of the pharmacies5,7will now be described, particularly with respect toFIG. 5. Each of the client computers187-193of pharmacies5,7is part of LAN65which interfaces these client computers to control computer209. Client computers211,213are located, respectively, at the technician work center85and the validation point81. Computers211,213include one or more input apparatus identical to computers187-193including a keyboard196, a machine-readable code scanner197, computer mouse199and touch screen201. Client computers187-193are located, respectively, at or near fulfillment centers73-79.

Control computer209is interfaced with host computer67of PIS69. Host computer67is electronically connected to pharmacy control computer209, through hubs215,217and patch panel219. Additional hubs221,223,225may be provided to electronically connect components of LAN65to control computer209. Computer terminals227,229at order entry point71are electronically connected in any suitable manner to host computer67as part of PIS69.

Control computer209is also referred to as a “controller” because of its role in controlling the pharmacy workflow as described herein. However it should be noted that the term “controller” may include any suitable device including computer209or may comprise the entire LAN65within WMS1.

An important advantage of the WMS1and its control architecture is that the system can be adapted to the unique needs of each pharmacy and can be modified as the needs of the pharmacy change over time. For instance, a retail pharmacy will tend to serve customers who require that medications be dispensed into vials59or bottles105. The prescription needs of retail customers tend to be based on prescription medications required over extended periods of time, such as a week or a month. Apparatus such as the dispensers91-97and159are suitable for this purpose as described above.

Hospitals or alternate site facilities, on the other hand, will tend to require dosage unit packages, such as packages108, which are segregated into separate cells separated by perforation lines and organized into the package strip shown inFIG. 7D. Each of the packages108represent a dosage unit to be taken by the patient, for example, on a particular day or at particular times during the day. Each package includes machine-readable indicia110, such as the bar codes shown, which identify all information necessary to match the medication to a particular patient. Other information, such as human-readable information identifying the patient name, medication type, instructions for taking the medication (such as the time of the day that the medication is to be taken) is typically printed on each package108.

The package strip shown inFIG. 7Dis of the type generated by an FDS brand automated dispenser (not shown) available from AutoMed Technologies. The FDS dispenser may easily be integrated into the WMS1. WMS1, therefore is easily adapted to serve the needs of the retail or hospital/alternate site pharmacy operator.

Moreover, if demand for medications at the retail and hospital/alternate site pharmacies should increase over time, any number of any number of additional dispensers, for example FastFill or FDS dispensers, could be added to the WMS1to address the changing needs of the pharmacy operator.

Referring further toFIGS. 2-4, the technician work center85shown therein is provided as a work area for initiating fulfillment of prescription orders and as a general work station. Technician work center85includes client computer211(or computers211) and the associated display and input apparatus195-201described above. While a separate technician work center85is highly desirable, it should be noted that the function of center85could be performed at any client computer within LAN65.

A sequenced prescription order is presented to the pharmacist241or filling technician247at the technician center85to initiate fulfillment. Specifically, the sequence in which the prescriptions are to be fulfilled is presented on video display195associated with technician center computer211. It is highly preferred that the prescription sequence is also presented in the form of a “sequence sheet”269which is a paper record of the sequenced prescriptions shown on the display195. The sequence sheet is printed before fulfillment of the prescription order and may be carried by the pharmacist241or filling technician247as she walks to the fulfillment centers73-79designated for fulfillment of the order. Sequence sheet269is preferably in the form of a tote bag into which each prescription is placed after fulfillment.

Sequence sheet269, while highly preferred, is not required as WMS1may operate in a “paperless” mode. In the paperless mode, the sequenced orders are presented on display195at technician center85and on the displays195of each fulfillment center73-79accessed to obtain medications required by the prescription order. The pharmacist241or filling technician247merely follows the workflow path as directed by the arranged text and icon storage location information313,315.

WMS1may be set in an automatic “automode” or in an “on-demand” mode using the mode selection control509provided on set up set up screen510(FIG. 30) presented on display195at technician center85or validation point81. If the program is in automode then prescription orders are placed in a FIFO queue associated with the prescription order database507for fulfillment one after the other. The pharmacist241or filling technician247merely fulfills each prescription order in the sequence in which the prescription orders are presented to him by the queue. Therefore, WMS1advantageously reduces the need for human decision making in the order fulfillment process reducing potential errors and minimizing the cost function.

If on-demand mode is selected, the prescription orders are manually selected for fulfilment by the pharmacist241or filling technician247in the manner described below with respect to the method. Again, WMS1provides easily understood direction to the pharmacy personnel with respect to the most efficient manner of prescription order fulfillment.

Both the automode and on-demand mode may be modified by designation of the customer as a “waiter,” meaning that the customer is waiting to pick up the medication. In such an instance, control computer209automatically places the prescription order for the waiting customer at the head of the list of pending orders. This modification occurs irrespective of whether automode or on-demand mode is selected. Further, the status of the prescription order is indicated to be that for a “waiter” as shown inFIGS. 10-11,22-24and28to alert the pharmacist241or filling technician247as to the status of the prescription order.

Typically, the status of the customer as a waiter is determined at the time the prescription order is placed for fulfillment at order entry point71and is part of the prescription order data supplied by PIS69to control computer209. However, the status of the prescription order may be modified in WMS1by selecting priority button329and then modifying the status of the pending prescription order on a separate set up screen (not shown) by designating the prescription order as being for a waiter or as non-waiter. The ability to modify the status of the prescription order based on whether the customer is waiting permits the pharmacist241or filling technician247to immediately respond to the needs of the customer, thereby better serving the customer.

A holding area231at validation point81may be provided to hold prescription orders after fulfillment but before validation. A work area233and adjacent wash basin235may be provided as an area for preparation and mixing of medications. A photocopy machine237may optionally be provided as may a facsimile machine239to assist the pharmacy personnel in performing their duties.

Validation point81is a work area within pharmacy5,7at which a pharmacist241validates the prescription orders. Validation point81includes a client computer213the associated display195and keyboard, scanner, mouse and touch screen input apparatus197-201described above with respect to the other client computers187-193and technician center computer211. The function of technician center85may be performed at validation point81. The function of validation point81within WMS1is described in detail below.

Order entry point71is a work area within pharmacy5,7at which order information is accepted by clerk253. A customer (e.g.,257or259) provides a written prescription to clerk253together with any other information required to initiate fulfillment of the prescription order. The information provided by the customer257will typically include the customer's name and address. The written prescription order provided by the customer257to the data entry clerk253includes the physician's name and, for each prescription within the prescription order, provides the type of medication prescribed, the medication dosage and quantity, the date prescribed, the physician's instructions to the customer, the number of refills allowed and whether a generic version of the medication may be substituted. Clerk253also obtains information from customer257with respect to his insurance coverage, co-payments and any other pertinent information relating to payment for the prescription order.

The prescription order information can be provided through direct interaction with customers or may be provided to clerk253via telephonic communication with a physician. Prescription order refill information may be provided to clerk253through any suitable means including via e-mail or computer interactive telephone communication also known as “IVR”.

Computer terminals227,229at order entry point71are provided to enter the prescription order information into the host computer67to which the terminals227,229are electronically connected. (Terminals227,229are identical and for purposes of brevity only terminal227will be discussed). Terminal227includes a video display195and keyboard, scanner, mouse and touch screen input apparatus197-201. Typically, a window is provided on display195which includes data entry fields provided to prompt clerk253with respect to the information to be supplied by customer257.

As described herein, PIS69resides on host computer67and includes the software program which is used to process a prescription order before release of the order for fulfillment by pharmacy5,7. It should be noted that in terms of prescription fulfillment process, what is required is a prescription which has been approved for fulfillment. Thus, the PIS69can be something as extensive as a nationwide network of interconnected pharmacies or something as minimal as an order entry station.

The prescription order information entered into host computer67is then adjudicated by PIS69. Adjudication involves processing the prescription order to determine that the prescription order should be fulfilled and to determine whether any special processing is required. For example, insurance and co-payment information is typically confirmed. The customer's medical records may be searched to determine whether there are potential adverse drug interactions potentially at issue.

If the prescription order is compliant with the adjudication process then the prescription order is sent by the PIS69to the control computer209and into a prescription order database507, preferably located on control computer209. As described below in connection with the method, WMS1conducts a review of the received prescription order to determine whether the data is in the proper format and sequence and to determine whether the prescription order can be fulflled by WMS1. The adjudicated order is then available for subsequent processing at the technician center85, fulfillment centers73-79and validation point81. The signal representing the adjudicated order cleared for fulfillment consists of data in any suitable structure and format.

Pick up point83is an area in pharmacy5,7where sales clerk255processes the prescription order and provides the fulfilled order to the customer, health care provider or other authorized person. Pick up point83is configured to meet the needs of the particular pharmacy. Pharmacies5,7include computer terminals275,277to process financial and customer information entered by sales clerk255. Terminals275,277may interface with PIS69. Will call area89is a storage location for fulfilled orders awaiting processing at pick up point83. Each prescription order at will call area89is held within a bin or shelf (not shown) organized by any suitable means, such as by the alphabetical order of the customer's surname. In place of a bin, the prescription orders may simply be held in the bag form sequence sheet for delivery to the customer.

Pharmacies5,7are staffed by pharmacy personnel including at least one registered pharmacist241,243,245one or more filling technicians247,249,251, an order entry clerk253and sales clerk255. Pharmacists241-245are capable of processing all aspects of prescription order fulfillment including the provision of advice and information and the important order validation step described in detail below and required before release of the prescription order to the customer257,259,261,263and265. The filling technicians247-251are responsible for obtaining the proper quantity and type of medications and products from the storage locations at fulfillment centers73-79for fulfillment of the prescription orders. The filling technicians247-251are also able to perform order entry, inventory replenishment and the tasks of clerk253. Filling technicians247-251are typically able to provide advice to customers257-265. However, filling technicians247-251are not authorized to validate prescriptions or prescription orders, as only pharmacists241-245are authorized to perform this task. Order entry clerk253is responsible for order entry at point71and is authorized to perform the sales clerk's255tasks. Sales clerk255is authorized to process sales transactions at pick-up point83.

Residing on control computer209is a software program260which includes pre-programmed instructions written to optimize the management of the pharmacy workflow, including the coordination of all mechanical and human resources of the pharmacy5,7as described herein. Program260has access to a medication inventory database513adapted to describe the medications stored at each storage location associated with the fulfillment centers73-79, including all non-automated and, if provided, automated dispensing devices91-97,151,159. The medication inventory database513includes a complete description of each medication comprising the inventory. The description includes any suitable parameters selected by the operator such as the medication name, an identification number assigned to each medication, a stock image, NDC number, type of packaging, if any, and inventory quantity. The precise storage location is also associated with each medication. For example, the storage location may be a specified cassette within an automated dispenser (e.g., dispenser91) or a row and shelf location of a static storage shelf (e.g. locations121,122,183).

Program260further includes a prescription order database507adapted to store the prescription orders received from the PIS69. Program260includes programmed instructions adapted to minimize the cost function associated with fulfillment of the prescription orders stored in the prescription order database. The programmed instructions enable: (1) for each prescription within the prescription order, selection of the medication storage location from which to obtain the medication required to fulfill the prescription; and (2) for each prescription order, determination of a prescription sequence corresponding to the sequence in which each prescription is fulfilled, first to last, within the prescription order. This optimization process and the various other steps carried out by program260to direct the workflow of the pharmacy5,7are outlined in the method of operation described below.

As mentioned in the background section, a simple cost function to be minimized by program260may be the total time to fulfill a prescription order or the total spacial distance traveled by pharmacy personnel in order to fill a prescription order. For example, for each order consisting of more than one prescription, the optimization process which is undertaken determines the sequence by which the individual prescriptions in the order are to be filled in order to minimize the total length of time required to fulfill the order. This determination can depend on more than the distance that must be traveled to obtain each prescription, but also can include the time and cost required to count (e.g., manual counting versus automated counting versus prepackaged). Thus, for medications which may be stored in more than one form (e.g., prepackaged and bulk), the optimization process also includes the selection of which location from which to obtain such prescription medications in order to obtain the least expensive form of the medication, thereby minimizing the cost function.

In addition to total time or total distance traveled, other cost functions can be utilized in order to achieve certain desired optimum performance. For example, the sequence of a particular order and the selection of the locations from which medications are obtained can also be influenced by orders which are filled immediately prior to or immediately following the filling of such particular order. This is of course relevant to situations in which several prescription filling technicians247-251are working at the same time in a pharmacy5,7. For example, if a bulk-form medication dispensing location (e.g.,91,93) is being used to fill one or more prescriptions, the optimization process may modify a sequence to “work around” such bulk dispensing or may direct the technician247to obtain a medication from an alternate location. In such a case, the cost function being minimized may be a more complex function of time, taking into account how filling times are affected by “neighboring” prescription orders. Alternatively, the cost function may be a combination of total time and a term or terms which penalize conflicts which may occur at storage locations. Note that with a cost function that takes into account “neighboring” orders, performance benefits are possible even with orders containing only one prescription if the pharmacy inventory stores some medications in more than one storage location.

Numerous other cost functions can be constructed to optimize the performance of WMS1by either penalizing or rewarding certain events or variables involved in the prescription fulfillment process. For example, in addition to time, distance traveled, and avoidance of simultaneous filling at the same location, the actual dollar cost of the medication to the pharmacy may be taken into account as well as the utilization of personnel, the need for inventory replenishment, and the special needs of the customer. Depending on the construction of the particular cost function chosen, the preprogrammed instructions would include all of the operational parameters and descriptive data required to evaluate such cost function. For example, in cases in which the filling times are used in the evaluation of total time, specific operational data on filling times would be included in the pre-programmed instructions of program260.

The preprogrammed instructions of program260for selecting the medication storage location and for sequencing will most likely reside in code on the control computer209. However, it is also possible that a portion of the program260could suitably be on other networked computers, for example a technician work center computer211or validation point computer213in LAN65.

Steps other than the optimization process are described in detail in connection with the method. Such steps include tasks to facilitate the workflow such as presentation (in human-readable form) of each prescription order, the prescription sequence and the storage location of the medication comprising each sequenced prescription before and after the medications and products are retrieved and generating a print_label command causing a networked label printer, for instance printer205, to generate an adhesive backed label279-285once a prescription has been fulfilled. The print_label command prompts the label printer (e.g., label printer205) to generate prescription information301,309,311,316and machine-readable indicia278for application to each label279-285for each sequenced prescription. The label279-285may then be applied to the container57,105or pre-packaged article153.

Method of Optimized Management of Pharmacy Workflow

The inventive system and method will now be further described, particularly with respect to the flow diagram ofFIGS. 9A-9Dand the screen display images ofFIGS. 10-30. The method is explained in the context of fulfillment of a hypothetical prescription order for a fictional person named Tom Gibson at pharmacy5. The four prescriptions comprising the hypothetical prescription order consist of “medications” in the form of candy or antacid rather than actual prescription medications or articles. It is to be understood that any medication or article stocked in the medication inventory may be dispensed according to the system and method. The flow diagram ofFIGS. 9A-9Duses the terms “customer” and “patient” interchangeably as the WMS1may be used for any person requiring fulfillment of a prescription order from a pharmacy.

Referring then toFIG. 9A, the first two functional boxes of the flow chart are functions which take place within PIS63associated with host computer67. Steps501,503indicate the entry and adjudication of the prescription order. The order is received in any suitable form, typically at order entry point71. The prescription order may, for example, be received in the form of a paper prescription, in electronic form or through WR. The prescription order is adjudicated by means of the PIS69as described above.

All of the remaining steps to be described inFIGS. 9A-Drepresent functions carried out within the inventive WMS1in conjunction with control computer209and LAN65(FIG. 5) as represented by the demarcation lines inFIGS. 5 and 9A. In step505, WMS1receives the adjudicated prescription order record from PIS69and the prescription order is entered into the prescription order database507, preferably residing on control computer209.

WMS1is set on one of two modes of prescription order fulfillment in a setup process (not modeled in the flow chart). The first mode is the automatic “automode” in which the prescription orders are automatically filled in a FIFO manner. The second mode is an “on-demand” mode which allows the pharmacist241or filling technician247to fulfill a prescription order immediately by manual selection of the specific prescription order presented on a display, preferably display195at technician work center85. The ranking of prescription orders in WMS1may be modified based on whether the customer or patient is waiting for the medication as discussed elsewhere herein. The screen display images shown inFIGS. 10-28represent WMS1processing the exemplary prescription order in the on-demand mode. Selection of the mode is made by the pharmacist241by selecting the appropriate setting509on set up screen510shown inFIG. 30.

Step511represents a check of the medication inventory database513to verify that WMS1is capable of fulfilling a particular prescription. Step515indicates that a negative response to step511has occurred and the pharmacist241or filling technician247is so informed. Step515reflects that a message (not shown) may be presented on display195at technician station85indicating that the medication could not be found. Specifically, the negative response step515would be triggered if the pharmacy5did not stock the type of medication required by the prescription order.

In step517, WMS1determines that an optimization process is required if the prescription order contains more than one prescription. If the prescription order contains a single prescription, WMS1skips forward to step523discussed below. There is no minimization of any cost function which does not take into account “neighboring” prescription orders when there is only one prescription in the prescription order.

If the prescription order includes multiple prescriptions, then WMS1commences step519. In step519, WMS1searches medication inventory database513and all applicable operational data, using all of the data which describes the prescription and the inventory, including the storage location of each medication, the quantity in inventory, the quantity required, the expiration dates, operational parameters and preassigned priorities. The search of step519is further based on the pharmacy layout (e.g.,FIGS. 2-4) and the current system setup.

WMS1carries out the optimization process of the invention in steps519and521. As described above, the optimization process results in the selection of the medication storage locations from which each medication will be obtained and the sequence in which fulfillment of the prescriptions comprising the prescription order will occur. Minimization of the cost function is the objective of the optimization steps519,521.

In step523, the optimized prescription orders are displayed, preferably on display195at technician work center85. The location from which each medication will be obtained is presented. The prescriptions307comprising the prescription order305are arranged in the sequence in which the prescriptions are to be fulfilled in order to minimize the cost function. Note that each order displayed has already been optimized according to steps519-521.

FIGS. 10-11show a series of exemplary screen image displays generated by WMS1on display195according to step523. While it is preferred that step523take place at technician station85, the step could take place using any video display electronically connected to LAN65. Referring first toFIG. 10, that figure shows a queue of pending prescription orders organized by customer name and presented by WMS1according to step523. The prescription order for Tom Gibson is one of the pending prescription orders in the queue. Mr. Gibson's name301is listed in the first row303of the prescription order305under the column for Patient/Rx. In the column for PickUp Time/Medication, Mr. Gibson is indicated to be waiting for the prescription order as of 12:00 a.m. on a Tuesday which is the 28thday of the month.

Each prescription307comprising order305is listed in a separate row303beneath Mr. Gibson's name. The prescriptions comprising the prescription order have been placed in the optimized sequence generated in steps519,521. In the example shown, computer209has determined that the order is most efficaciously fulfilled by filling first from the apparatus at fulfillment center73followed by fulfillment at fulfillment centers79and75, an example of routing the work flow around a center75that is busy fulfilling another pending order. The collection of prescriptions arranged in the optimal sequence is referred to herein as a “prescription sequence.” Each prescription307includes a prescription number309, a description of the medication in human-readable form311, identification of the medication storage location of the medication by address313and icon315and the medication count316. A stock image318of each medication corresponding to each prescription is provided.

The medication storage address313includes a text description of the exact cassette, shelf or other storage location where the medication is stored. For example, the TIC TACS for the first prescription are located in FastFill-Cassette #2 while the CALTRATE 600 Plus of the third prescription is located at Shelf-3C11. The icon315corresponds to one of the fulfillment centers73,75,79provided at pharmacy5. For example, the icon315address corresponding to the first and second prescriptions in Mr. Gibson's order corresponds to fulfillment center73for dispensers91-97, while the icons associated with the third and fourth prescriptions correspond, respectively, to fulfillment centers79,75for storage shelf units163,165and dispenser151. The information associated with each prescription order is not limiting and may be tailored to meet the needs of the particular pharmacy operator.

As shown inFIGS. 10 and 11, pharmacist241or filling technician247selects Mr. Gibson's prescription order for fulfillment by touching the row303associated with Mr. Gibson's name followed by touching “Process” button317causing row303and the associated process box319to darken in color indicating the selection. Mr. Gibson's order may be located by scrolling up or down using touch arrows321or by searching for the customer name using a data entry field (not shown) presented on display195and accessed by touching the “Check Order” or “Find Manually” buttons323,325. Other optional buttons may be provided including an “Active Order” button327which causes WMS1to present a list of all pending prescription orders, a “Priority” button329which permits the pharmacist241or technician247to prioritize pending prescription orders for fulfillment (e.g., to designate a customer as a “waiter”), a “Setup” button331which permits access to setup screens (FIGS. 29,30) to change the WMS settings, a “Reprint Menu” button333and a “Cancel” button335which cancels an action.

Returning to the method, in step525selection of a particular displayed prescription order (i.e., the order for Tom Gibson) causes WMS1to distribute the prescriptions to the selected medication storage locations in fulfillment centers73,75and79. Note that in automode, the distribution of prescriptions to the selected locations occurs in advance of the pharmacist preselecting a particular prescription order.

Referring next toFIG. 9C, fulfillment of the selected prescription order may occur in a paperless mode (steps527-535) or in a mode utilizing a sequence sheet269(steps537-545).

Referring first to the mode utilizing the sequence sheet269, step537shows that a sequence sheet269(FIG. 8) is printed by printer203connected to LAN65and preferably controlled by control computer209. Sequence sheet269is preferably a bag printed on one side by printer209. It is intended that the sequence sheet269is carried by pharmacist241or filling technician247about the pharmacy5during collection of the medications pertaining to the prescription order. Sequence sheet269in effect acts as a “map” directing the pharmacist241or filling technician247along the most efficient path for fulfillment of the prescription order. The preferred bag-form of the sequence sheet269serves as a tote holding the fulfilled prescriptions during the process of prescription order fulfillment.

The prescription sequence is presented on sequence sheet269in the same arrangement as on the images displayed on the video display of step523. (FIGS. 10-11). In addition to displaying all of the information shown on the video display195(FIGS. 10-11), sequence sheet269also includes machine-readable indicia271, such as a bar code which corresponds to each prescription. Customer name301, prescription number309, prescription type311and address313,315information for the order305may be provided. Additional information or instructions273may be printed on sequence sheet269, including compounding instructions (e.g., “add water”), information about the medication packaging or special location information, such as storage in a refrigerator.

The sequence sheet269may be adapted for use as a “consulting” tool by including detailed information about each prescription in the order. For example, the sequence sheet could include text adjacent each prescription307with detailed instructions for taking the medication, such as the time of day the medication should be taken. Other detailed information might include information about potential side effects or drug interaction information. All of the prescriptions comprising the prescription order may be placed in the bag-form sequence sheet269and the entire bag could be provided to the customer at pick up point83. Thus, the sequence sheet269would serve to package the prescription order and provide the customer with useful information about the prescription order.

Also according to step537, pharmacist241or filling technician247walks to the fulfillment center73associated with the storage location of the first among prescriptions307of the prescription order305. In the prescription order for Mr. Gibson, the first and second prescriptions are to be fulfilled, respectively, from bulk-form medication dispensers91and95, both of which are at fulfillment center73and are controlled by the same client computer187and display195. As shown inFIG. 12, display195located adjacent dispenser91has presented thereon the two prescriptions to be dispensed, respectively, from bulk-form dispensers91,95. For purposes of consistency, the information for each prescription presented on display195at fulfillment center73corresponds to the information presented on the display of step523(FIGS. 10-11) and on sequence sheet269. The display ofFIG. 12further provides container icon314directing the pharmacist241or filling technician247to select a particular type of container to hold the medication to be dispensed. In the example ofFIG. 12, the containers pertaining to the first and second prescriptions are each vials59having an 8 DRAM capacity. The NDC number and prescription quantity are also presented on the screen represented byFIG. 12.

In step539, pharmacist241or filling technician247utilizes a hand-held scanner197electronically connected to LAN65to read sequence sheet269bar code271associated with the first prescription. Scanning of the bar code271triggers generation of an initiate_dispense signal to control computer209which causes dispenser91to release the medication associated with the first prescription into a hopper or chute (not shown) within dispenser91. The code271corresponds with the prescription number309and is a unique identifier of the prescription307. Therefore, the code271essentially points to all of the information associated with the prescription307including, for example, customer and prescription order identification, and the type, strength and quantity of medication to be dispensed. Control computer209(or another computer within LAN65) activates the appropriate medication storage location (e.g. a cassette such as cassette99-103) within dispenser91based on information within the medication inventory database513and meters the appropriate quantity into a hopper or chute in dispenser91in preparation for dispensing into vial59.

In step541, the empty vial59is placed under a spout109, and the medication is dispensed into the vial59. For the dispensers91-97, the act of manually lifting a gate (not shown) near spout109triggers the medication_dispensed signal and causes the dispenser to dispense the medication into the vial59. The medication_dispensed signal informs control computer209that the medication has been dispensed in the proper quantity. Typically, if the quantity is incorrect an error signal is generated to inform the pharmacist241or filling technician247thereof. The aforementioned process will vary depending on the type of automated dispenser being utilized. For example, the medication_dispensed signal may occur without human intervention in the dispensing process.

In step543, a print_label command is generated by control computer209in response to this agreement between the initiate_dispense and medication_dispensed signals. This process along with the controlled management of the medication inventory ensures that the correct medication at the correct quantity and strength is matched to the correct customer, thereby significantly reducing potential for error. The print_label command causes label printer205to generate a label279corresponding to the first prescription and including the customer name301and prescription number309, the type311and quantity316of the medication, the physician who prescribed the medication, the fill date and other information, such as the number of permitted refills. Label279is adhesive-backed and is manually placed on vial59by pharmacist241or filling technician247. The vial59may then be placed in the bag-form sequence sheet269.

According to step545, steps537-543are repeated if the prescription order includes more than one prescription. With respect to the prescription order for Mr. Gibson,FIG. 14shows the state of display195following dispensing of the first prescription but before dispensing the second prescription from bulk-form dispenser95. The prescription information for the first prescription is deleted because that prescription has been fulfilled. Steps537-543are then repeated as described above resulting in dispensing of the medication for the second prescription from dispenser95through a spout (such as spout109) and into a vial, such as vial59. Label281is printed by printer205for attachment to vial59.

The third prescription in Mr. Gibson's order is to be filled at fulfillment center79utilizing manually-accessed shelves163,165as indicated by the storage location information313and icon315on the sequence sheet269and stock image information318onFIGS. 10-11and16.FIG. 16is the image presented by WMS1on shared display195serving fulfillment centers75,79adjacent to shelves163,165.FIG. 16shows the single prescription307assigned for fulfillment at shelves163,165.FIG. 2Ashows the storage location code183and cell173for container179which holds the CALTRATE 600 called for by the prescription order305.

Steps537-543are repeated as described above resulting in manual selection of container179holding the CALTRATE 600 product. Fulfillment of the third prescription differs only from steps537-543in that the medication_dispensed signal is generated by reading (with scanner197) a bar code (not shown) on the container179for the CALTRATE 600 product. Additionally, label283is printed for attachment to the container179for the CALTRATE 600 product. As shown inFIG. 18, a message box337may be presented on display195at center79presenting a stock image339and permitting verification of the manually-picked product. Selection of the “Ok” button341following visual comparison of the stock image318and medication completes the process of fulfillment of the third prescription.

The fourth prescription in Mr. Gibson's order is to be filled at the fulfillment center75automated pre-packaged article dispenser151as shown by the storage icon315on the sequence sheet269and icon information315onFIGS. 10-11.FIG. 19is the image presented by WMS1on display195located adjacent to center75and dispenser151.

Steps537-543are repeated as described above resulting in dispenser151dropping the package (such as package153) containing the CERTS product into bin155. Like fulfillment of the third prescription, the medication_dispensed signal is generated by reading (with scanner197) a bar code (e.g., bar code154) on the package (not shown) for the CERTS product. Additionally, label285is printed for attachment to the pre-packaged container for the CERTS product. All containers for the four prescriptions may then be forwarded to the pharmacist for validation as described below.

The paperless system of steps527-535will now be described with respect toFIG. 9C. According to step527, the pharmacist241or technician247walks to the center73associated with the first prescription order as shown inFIGS. 10-11. No sequence sheet269is provided or needed in the paperless system. The pharmacist241or filling technician247then touches the display195touch screen201adjacent the customer's name301causing step525, the distribution step, to occur (FIG. 11).

In step529of the paperless system, a prompt343is generated after selection of the desired prescription as shown inFIGS. 13,15,17and20. Selection of the “Yes” or “Ok” button345confirms correct selection of the prescription and generates the initiate_dispense signal. Steps531-533of the paperless system are identical to steps541and543of the mode using the sequence sheet and the description of such steps for each of the four prescriptions comprising the Gibson prescription order is incorporated herein by reference. All of the fulfilled prescriptions are then forwarded to the pharmacist for validation as described below.

Validation of the prescription order305is represented by steps549-555onFIG. 9D. Validation is the review process wherein each prescription comprising the prescription order is inspected to ensure that the prescription order has been fulfilled correctly and in accordance with the prescription order. Validation includes, for example, confirmation that the prescription order is matched to the correct customer, confirmation that all prescriptions within the prescription order have been fulfilled and confirmation that the correct medication has been matched to each prescription. Validation may be accomplished through program260or through a separate software program residing, for example, on validation point computer213or on control computer209.

In step549, the fulfilled prescription order is provided to the pharmacist241for validation at validation point81. Pharmacist241selects the prescription order305to be validated from the queue of pending prescription orders presented on display195by WMS1as shown inFIG. 22. In the example, pharmacist241selects Mr. Gibson's prescription order305for validation by touching the row303associated with Mr. Gibson's name. Mr. Gibson's order may be located by scrolling up or down using touch arrows321or by searching for the customer name as described above. As shown inFIG. 23, WMS1then displays Mr. Gibson's prescription order for validation, removing all other pending prescription orders from view on display195.

As can be seen onFIG. 23, Mr. Gibson's prescription order includes the four prescriptions307in the optimized prescription sequence for that prescription order305. Each prescription307includes the same information as shown inFIG. 10including the prescription number309, description of the medication type311, identification of the medication storage location by address313and icon315and the medication count316for each prescription307. A stock image318of each medication is provided.

The package icons339associated with each prescription indicate that each prescription has been properly dispensed by the automated dispensers and that manually-selected prescriptions have been duly scan verified by a pharmacist241or filling technician247to generate the medication_dispensed signal.FIG. 28represents the state of the order if the prescriptions are not verified as being correctly dispensed. The absence of the package icon339for each prescription indicates that heightened scrutiny of the prescription order is warranted.

In step551, the pharmacist validates the first prescription in the prescription order. The pharmacist241selects the prescription to be validated by (1) touching row303associated with the prescription307, (2) by scanning the bar code278on label279with a scanner197or (3) by scanning the prescription bar code271on the sequence sheet269with reader197. Selection of the prescription generates a first validation signal received by control computer209or another computer in LAN65.

Pharmacist241then visually inspects the dispensed medication and compares the medication to the stock image318presented by WMS1on display195. In the case of medications dispensed by a fully automated dispenser159, the pharmacist241would compare the digital image of the medication captured by the dispenser159to the stock image318. As shown inFIGS. 24-27, the stock image318can be enlarged by touching the touch screen201on stock image318. The enlarged image318assists the pharmacist241with the inspection and may be presented together with the customer name, NDC number and medication description. If the prescription has been filled properly, the pharmacist241scans the bar code278on the label279with scanner197generating a second validation signal received by control computer209or another computer in LAN65. If the control computer209(or other LAN65computer) determines that the first and second validation signals are in agreement then the validated prescription is available for release to the customer.

According to step553, the validation process is repeated for each prescription in the prescription order. The entire prescription order is released once the control computer209, or other LAN65computer, has received agreement on the validation signals for each prescription in the prescription order. The check marks347next to each prescription307signify that the prescription has been validated.

Validation is completed according to step555when the pharmacist241places all prescriptions in a bag or other container (not shown) at the pick up point83for pick up by the customer263. Sequence sheet269may be used for this purpose.

An optional control may be imposed on validation by requiring entry of a personal identification code indicating authority to validate the prescription order. The identification code may be typed into a data entry field or may be a code on a pharmacist's identification badge which is read by scanner197before commencement of validation. WMS1denies access to validation for unauthorized pharmacy personnel.

A replenishment process may be provided in the context of the pharmacy with optimized workfilow and such replenishment process is embodied by steps557-563. According to step557, program260updates the quantities in inventory as medications and other articles are dispensed from medication storage locations. Also in step557, WMS1automatically contacts the vendor of the medication or article which has reached a predetermined level of inventory depletion. WMS1places an order for replenishment of the inventory with the vendor.

In step559, the replenishment order is received, processed and fulfilled by the vendor. As part of this step, the vendor sends the ordered medication or article to the pharmacy. Preferably, the medication or product is in a container (not shown) with a machine-readable code (e.g., a bar code) corresponding to the product, including product identification and lot number, a product quantity and an expiration date.

In step561, a filling technician247scans the code on the product received from the vendor and is directed to the appropriate medication storage location in WMS1. Filling technician247may use a hand held computer349shown inFIG. 31for this purpose. Hand held computer349includes a machine-readable code scanner351and interfaces with LAN65and program260. (The filling technician241may optionally initiate replenishment by entering his personal identification code into computer349thereby enabling the WMS1to identify the person responsible for the replenishment.) Scanned information is entered into computer349and information from a database on the computer349is presented on the computer display screen353providing information directing the filling technician247to the medication storage location at which the medication or product is to be stored. The storage location may, for example, be a cassette101in dispenser91, a storage shelf163or a location in an automated prepackaged-form medication dispenser151.

According to step563, the filling technician247then scans a machine-readable code (e.g., code122,124,184) at the designated medication storage location (e.g., cell173, or shelf115inFIG. 3D) and on the product container, preferably using hand held computer349. If there is agreement between the identified medication and the scanned storage location, the filling technician receives a prompt from computer349directing him to replenish the medication.

The filling technician247then places the medication or product into the designated storage location completing the replenishment process. The filling technician247could also manually enter information about the restocked medication into computer349. Such manually-entered information could include the product identification and lot number, the precise product quantity placed into inventory and the expiration date.

The information collected on computer349is then supplied from computer349to program260to increment the inventory into the WMS1and to provide current medication inventory information to WMS1, including the exact storage location where the medication is stored and the quantity of medication at that location. The availability of accurate and current medication inventory information to WMS1greatly facilitates accurate sequencing of the prescriptions during the prescription order fulfillment process described above. The replenishment process imposes levels of security and control ensuring that the medication inventory database513and the actual medication inventory are in complete agreement.

The replenishment process described herein permits the pharmacy operator to not only replenish the inventory but to closely monitor the condition of the medication inventory. For example, the same medication may be stored at different medication storage locations within WMS1. Such medications may have different expiration dates. By tracking the expiration dates of medication in the medication inventory and by selectively replenishing the older inventory it is possible to maintain a medication inventory including the most potent medications thereby improving service to the customer.

Example and Data

In order to verify the advantages of the present invention, a simulation of pharmacy workflow was performed using a computer model of a typical partially-automated pharmacy layout, the number and type of prescription orders for a typical week, and a normal complement of pharmacy personnel. The system simulated consisted of an AutoMed FastFill system, an AutoMed QuickFill Plus system, and several static storage shelves.

Comparison was made between this system with no workflow optimization and the same system with the inventive optimization process used to select the storage locations from which to obtain medications and to determine the best sequence in which to fill the prescriptions within each prescription order. The cost function chosen for the simulation was total time to fill prescription orders.

A one-week prescription load of 2205 prescriptions was simulated, including 309 multi-prescription orders with an average of 2.5 prescriptions per multi-prescription order. The improvement achieved in the simulation indicated that under these workload assumptions, there was a 5.5% decrease in the average time required to fill an order.

Of the 309 multi-prescription orders, 219 consisted of two prescriptions and 60 contained three prescriptions. In an order environment in which a higher percentage of the orders are multi-prescription orders having a higher average number of prescriptions per multi-prescription order, an even higher benefit is expected. Further benefit is possible with a cost function which takes into account “neighboring” orders since such a cost function is designed to provide efficiency improvements for some percentage of the single-prescription orders, depending on how many of the medications in the inventory have more than one storage location from which they can be obtained.

While the principles of the invention have been shown and described in connection with specific embodiments and steps, it is to be understood that such embodiments are by way of example and are not limiting.