By Kate Baggaley

Smart speakers offer one avenue for artificial intelligence to streamline pharmacy workflow, according to a presentation at ASHP Pharmacy Futures 2024, in Portland, Ore. 

When a Texas hospital system installed Amazon Echo Dots in patient rooms and in the pharmacy, the devices not only answered patients’ medication questions but also sped up the administration of urgently needed bleeding reversal agents by up to 75%.

AI presents implications for “almost every single step in the healthcare continuum,” said presenter Ghalib Abbasi, PharmD, MS, MBA, the system director of pharmacy informatics at Houston Methodist Hospital System. These range from patient care to the role of pharmacists and pharmacy technicians. “AI is not going anywhere; it’s just [a matter of] how and when you’re going to use it.” 

The first problem that Dr. Abbasi and his colleagues addressed via the smart speakers was that patients don’t always recall providers’ counseling related to a drug they have been newly prescribed. 

Dr. Abbasi and his colleagues first used the smart speakers to help patients recall providers’ counseling related to a newly prescribed drug. When patients initiate a discussion with the smart speaker, the device asks them which medication they would like information about. 

“The patient would respond, for example, lisinopril,” Dr. Abbasi said. “The device can answer, ‘OK, great, what do you want to know about this? Side effects or drug info?’” Depending on the patient’s response, the speaker will list the top three side effects or general drug information, he noted.

If the medication in question isn’t listed in the speaker’s preloaded database, or the patient requires further information, their query is treated as a message to the pharmacist within the electronic health record (EHR).

“Within the EHR, a pharmacist can go and access the chart, see exactly which medication the patient’s asking about … and the pharmacist would then call back the patient on the Echo Dot,” Dr. Abbasi said. 

The smart speakers are programmed to recognize several different pronunciations of a given drug. If the speaker fails to recognize the drug name a patient offers, a request is sent to the pharmacy to call the patient.
Houston Methodist also used the smart speakers to quickly verify orders for bleeding reversal agents. “In this case it’s a very life-threatening situation,” Dr. Abbasi noted. When a provider signs a bleeding reversal agent order, the order enters a queue for pharmacist verification. The Echo Dot then audibly announces to the pharmacy that an urgent order awaits pharmacist attention, and the speaker’s base flashes with a yellow notification ring.

Excluded from this process are auto-verified orders and duplicate orders for the same patient signed at the same time. Included are four bleeding reversal agents:

• protamine sulfate
• prothrombin complex concentrate
• andexanet alfa
• idarucizumab (Praxbind, Boehringer Ingelheim)
  

After the devices were installed in three of Houston Methodist’s eight hospitals, the turnaround time from provider order signing to nursing administration of these medications decreased from 36 to 24 minutes (a 35% reduction) at one facility, 40 to 24 minutes (40%) at the second and 80 to 20 minutes (75%) at the third. Houston Methodist is in the process of expanding the Echo Dot service to additional hospital pharmacies in the hospital system, Dr. Abbasi said. 

He noted that the smart speakers can be applied to other problems as well, such as providing summaries of conversations between providers and patients—a feature called “ambient listening.” In addition, Houston Methodist is working on using the devices to answer pharmacists’ questions about their patients. “The pharmacists query data right from their desk from the device. So, you can sit down and talk to the device and say, ‘Hey, give me the lab results for John Smith for today,’” Dr. Abbasi said. “[Or] you can say, ‘Hey Alexa, tell me the difference between the home [medications] and the inpatient [medications] for John Smith.’”

Dr. Abbasi reported no relevant financial disclosures.