Lucy (left) and Buddy (right) and their best friend Lea Mullins, AVP, pharmacy operations, at Ballad Health
Photo: Lea Mullins
Ballad Health is a 21-hospital health system serving 29 counties across Northeast Tennessee and Southwest Virginia. Each of those hospitals used to operate an entity-owned pharmacy with its own staff and medication inventory. But that decentralized structure created a lot of redundancies and inefficiencies.
THE CHALLENGE
The hospitals all had to hire and keep pharmacy technicians and pharmacists. The challenge only got tougher after COVID-19, when workforce shortages worsened. In some locations, Ballad just couldn't find enough staff, leaving existing teams stretched thin and spending more hours on repetitive, manual dispensing tasks than on caring for patients.
Managing inventory was another uphill battle, said Lea Mullins, assistant vice president of pharmacy operations at Ballad Health. She holds a doctorate in pharmacy.
"With each entity-owned pharmacy maintaining its own supply, we faced issues with expired medications and a lack of formulary compliance," she explained. "It wasn't unusual for medications to sit unused at one hospital while another site ran short.
"Critical drugs were also running out in areas where they were urgently needed and delaying treatment, even though the same medications were just sitting on shelves elsewhere in the health system," she continued. "That fragmentation was both costly and a risk to patient safety."
And during all of this, Ballad also was battling rising pharmacy costs and nationwide drug shortages. Leaders and staff realized that if they wanted to improve patient safety, reduce costs and make the best use of limited pharmacy staff, they needed to fundamentally rethink how they delivered medications across the 21 hospitals.
PROPOSAL
The central distribution replenishment pharmacy (also known as the central fill pharmacy) model gave Ballad a way to consolidate medication distribution into a single hub that could serve the entire health system.
Instead of running duplicative pharmacy services at each hospital, the health system would use robotic automation to handle dispensing and packaging centrally, then distribute medications to automated dispensing cabinets located throughout the facilities.
The Omnicell XR2 robot is the key, Mullins said.
"Previously, six to eight pharmacy technicians spent about four hours a day just to pull medications from the central pharmacy shelves for distribution across each hospital – this was in the startup phase of the central fill model," she explained.
"The XR2 automates that process, retrieving and preparing medications in a fraction of the time. Eliminating that manual step has helped us free up valuable technician hours and reduce the chance of human error.
"Another key piece – especially from a safety perspective – is barcode verification," she continued. "With the new system, 100% of medications are barcode-scanned before being loaded into dispensing cabinets. That gives us confidence in both accuracy and safety, helping to address one of the most common sources of hospital errors nationally."
At the same time, consolidating inventory gave Ballad better formulary adherence and tighter control over waste. Medications that might otherwise expire at one facility could now be redistributed across the health system as needed.
"In short, the proposal was about efficiency, but it was also about building a safer, more resilient pharmacy model that could adapt to today's realities," Mullins said.
MEETING THE CHALLENGE
Once the central fill pharmacy was up and running, workflow changed dramatically. Today, three dispensing robots (nicknamed Dolly, Johnny and June by the team), along with carousel systems, handle most of the medication picking, packaging and verification.
Pharmacy technicians oversee the process at the central hub, making sure the machines are stocked and orders are filled accurately. Medications are then delivered and stocked into Omnicell XT automated dispensing cabinets located in nursing units, operating rooms and other care areas across the hospitals.
"These dispensing cabinets are fully connected to our clinical systems, including our electronic health records and physician order entry," Mullins noted. "Medication orders flow seamlessly from providers and ultimately to the centralized pharmacy hub, where the automation prepares medications that are then restocked in the cabinets on the floor.
"Nurses and pharmacists at the point of care access the cabinets to administer medications, with barcode scanning and controls in place to ensure safety," she added.
The staffing impact has been significant. What used to require dozens of full-time equivalent employees scattered across multiple hospitals can now be handled centrally by 21 FTEs.
"Importantly, this didn't cause a reduction in our workforce – it was a way of working around shortages that had left open positions unfilled and redeploying the staff we do have for higher-value activities," she explained.
"Instead of chasing hard-to-hire technician roles at each site, we could concentrate our staff at the hub and redeploy pharmacists to focus on clinical activities, such as medication reconciliation, patient education and interventions," she continued. "In other words, automation didn't displace people. It made it possible for our limited team to work smarter and have greater impact at the bedside."
RESULTS
Ensuring patient safety has been one of the most significant outcomes. With 100% barcode scanning and automation handling much of the dispensing process, Ballad has dramatically reduced the risk of medication errors, Mullins reported.
"Given that drug mistakes are one of the most common medical errors in hospitals nationally, being able to verify every dose before it reaches a patient is a major safeguard for our health system," she said.
"Another measurable result has been workforce efficiency," she continued. "Filling cabinets used to consume more than 240 technician hours across the team, per day per site. Today, our central hub manages that same workload for the entire health system with about 17 FTEs per day."
This shift has been especially critical at a time when recruiting and retaining pharmacy technicians is one of the toughest challenges hospitals face. By streamlining dispensing, Ballad has freed up pharmacists to practice at the top of their licenses and spend more time on medication reconciliation, patient education at discharge and clinical review – rather than mechanical dispensing tasks, Mullins said.
"We've also reduced both stockouts and waste," she noted. "By tracking utilization patterns and adjusting minimum and maximum stocking levels, we've been able to prevent stockouts and reduced waste by more than 64%, ensuring patients have timely access to needed therapies. Central inventory control has also minimized expired medications and improved formulary compliance, directly lowering pharmacy spend.
"Perhaps most visibly, our central fill pharmacy model played a key role in our health system's ability to reopen Lee County Community Hospital, a rural facility that had been closed for nearly a decade," she added. "Prior to the reopening, the community residents were traveling 60-75 minutes for care. Without the central fill model, it would not have been financially feasible to staff and operate an entity-owned pharmacy at that location."
Today, that hospital provides emergency care to 50-60 patients daily, inpatient care to 6-10 individuals at any given time, and has delivered 10 babies since reopening.
"We look at it as more than just a success metric – it's truly a restored lifeline for an underserved community," she said.
ADVICE FOR OTHERS
Mullins' first piece of advice for her peers would be to approach pharmacy automation, not just as a cost-saving measure, but as a patient safety and workforce strategy.
"The technology can absolutely deliver financial efficiencies, but its true value is in standardizing processes, reducing errors and freeing up clinical pharmacists to spend more time with patients," she said. "If you frame the initiative around those goals, you'll gain much stronger buy-in from clinicians and leadership.
"Second, be prepared to rethink longstanding workflows," she continued. "Many of us were used to filling cabinets daily, simply because 'that's how it's always been done.' With automation and central distribution, you have the opportunity to study utilization patterns and tailor stocking levels more strategically, with clearer insights into what is needed where, and how often."
That requires a willingness to let go of legacy processes and embrace data-driven decision-making, she added.
"Finally, don't underestimate the importance of thoughtful change management," she advised. "Introducing automation and centralization affects every corner of the hospital operation, from technicians to nurses to providers.
"Clear communication, training and collaboration are essential to make the transition smooth," she concluded. "But once you get past the initial adjustments, the benefits in terms of safety, efficiency and sustainability are worth it."
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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