As Kirby Lester marks its 40^th anniversary in 2011, ComputerTalk senior editor Will Lockwood caught up with CEO Garry Zage to talk about where pharmacy has been, where it's going, and the role he sees automation playing.

CT: First, let me offer my congratulations for Kirby Lester's 40 years of serving pharmacy. You are also marking six years as CEO and owner, and there've been a number of changes in the past few years.  Tell me about where the company was when you took over and how you are executing your vision for it.

Zage: We're very proud of carrying the Kirby Lester name into its fifth decade. One thing that was clear when we bought the company was that it was one of the best-known and most respected brands in pharmacy technology.  We looked at the success the company had with only two products and no outside sales force and saw tremendous opportunity to build the brand and expand the product portfolio. We brought in a team of executives that had experience doing just that. In fact, our team has over 100 year's of combined executive experience with pharmacy automation.  Even still, it took time for people to understand that we were bringing out technology aimed at current market requirements under the Kirby Lester name.  People didn't immediately understand that it wasn't your grandfather's basic pill counting machine anymore.

At left, a row of Kirby Lester counting devices, which show the development of the company's technology.  Zage points out that all still function.

CT: And how do you assess your efforts so far?

Zage: When I travel and see our technology in action in a pharmacy, I feel that we've done well. For instance, I was in a pharmacy in Providence, RI recently. I was behind the counter and I felt a sense of great pride to see our KL60 robot dispensing the pharmacy's top moving medications; right next to it was our table-top counting system taking care of the balance of medications that were not being dispensed by our robot. It was the total solution, all from Kirby Lester.  People there were relying on our products, which fit seamlessly into their pharmacy layout and workflow. It gives me particularly great pleasure to see our newest technology, the KL60 robot, as part of their process and to work it like it's been there for years. Everyone already knows us for our table-top counting technology and now it is gratifying to see our products in use at the highest level.

CT: Garry, tell us a little bit about yourself. How did you get to where you are today?

Zage: I'm a graduate of the University of Illinois College of Pharmacy. I have experience in dispensing in the retail and hospital settings. Out of pharmacy school, I spent a couple years at the Loyola University Medical Center in Maywood, Ill., which is a tertiary care center. Then I moved to a pharmacy management role at St. Joseph's Hospital in Chicago. After two years of pharmacy management experience, I was promoted into hospital administration in the professional services division, where I had the opportunity to build ancillary revenue programs, such as a diabetes center, a home care program, and a nutritional support service as well as manage 10 hospital departments, including pharmacy. From there I moved to American Hospital Supply, where I was involved in building a homecare company. AHS was purchased by Baxter, where I then spent 10 years in business development, corporate sales and marketing strategy, and finally assisting in the launch of a clinical nutrition company as a joint venture. I resigned from my corporate position and went out on my own with a boutique development firm that helped companies and people with products who needed help understanding how to approach the healthcare market, compete with the existing products, develop strategic plans, and secure funding.

CT: That's quite a range of experience.  And was acquiring Kirby Lester the next move then?

Zage: I became aware of Kirby Lester while running my development firm. A few wholesalers were calling on the company's founder, Rod Lester at the time and asking him what his plans were for the company. I knew the company's products from my time in school and in pharmacy practice.  As I mentioned earlier, it was a name everyone knew and trusted, but I could also see that they weren't developing any new products. I was eventually able to buy the company in September 2005. It was a great opportunity as I felt that I really understood the trends in automation, but I also had the experience base of developing and financing new products.

CT: And so your strategy was to build on the brand by developing new products based on the trends you were seeing?

Zage: Yes, that is correct. I wanted to take this to the next level, to the point where we can provide the most technologically advanced product, coupled with the gold standard Kirby Lester counting technology inside. We knew we wanted to stay with the tradition of offering products with a small footprint and low price point. Then we looked at what else we could do, and we realized our products needed to interface with the PMS [pharmacy management system]. When we bought the company in 2005 all of the products were standalone. So, we then integrated with each of the PMS vendors and then added inventory control, and provided tools that allowed for total quality assurance during dispensing. For example, we introduced biometrics for logging activity, advanced inventory tools, and a verification system with drug imaging. We took all this technology and built it on top of the core counting technology. Ultimately we were looking to increase efficiency, and control errors and miscounts in a way that is very cost effective.

CT: How did you decide which features, such as the PMS interface, to focus on?

Zage: One of the first things we did was develop a national advisory panel with a national chain executive, a national supermarket pharmacy executive, a representative from an innovative regional chain, and a regional grocery store pharmacy. This panel is our sounding board. Our philosophy is that we should never think that we know the pharmacy market better than the folks behind the counter. The last thing want to do is have our engineering staff develop a product that has no applicability to the market. Our advisory panel helps us understand what the needs are, where the market is going, and how we as a company can work with these trends in our development efforts without developing a "me-too" product.  We look at product development as finding out what we can offer that's different, unique, and that answers many of the questions and concerns that exist in the pharmacy marketplace.

Kirby Lester's Sarah Schwoerer and Nick Tinsley with a pair of KL60s in the training and delivery prep area.

In fact, the fully automated KL60 dispensing robot is a perfect example of listening to our customers (pharmacists) and understanding their needs.  In 2006 we participated in a meeting with 12 regional chains.  They told us about this huge gap in what they wanted, and what was currently on the market. They all wanted to install robots in their pharmacies, but the cost and footprint was prohibitive at the company-wide scale. The asked us if we were interested in developing a smaller, lower-cost robot.  This conversation launched our thought process to develop the KL60, the market's first and only compact, affordable robot. The idea came from listening to our customers and the market.

CT: So, combining your experience, the input you receive from the market itself, and the perspective afforded by your advisory panel, what are the trends and issues that pharmacies are looking to dispensing automation for now?

Zage: There's still a lot of variation in the technology that pharmacies have deployed. Some have little to no technology, no workflow software, no automation. Then there are pharmacies that have made these investments and are looking at building their future business around patient consultative services.  And there's a whole continuum between these two extremes. I believe the trend that's going to become the standard of care is MTM.  The opportunity to see real savings in healthcare costs from MTM, coupled with a decrease in the number of primary care physicians, means there's a real opportunity for pharmacies that can figure out how to utilize the appropriate level of technology that allows them to provide a higher level of patient care.

CT: This seems like a point where dispensing automation comes into play, right?

Zage: That's right. One reason is that automation can help free up the pharmacist, to give him or her more time. With this in mind, we ask pharmacies evaluating our technology what they are going to do with the time that our technology effectively eliminates from the dispensing process.

CT: And what kind of answers do you get?

Zage: Beyond MTM, it's clear that vaccinations and immunizations are big opportunities. Also, many pharmacies look to expand their role in senior health, providing additional drug information and education sessions, or venturing into skilled nursing and assisted living pharmacy services.

Getting back to the role of automation, one approach might tell you that you need more pharmacists to provide these services. Another approach might look to central fill and remote verification: you may be able to reduce your labor needs or simply reallocate existing labor.  So there are interesting dynamics right now in the profession. You have people still fulfilling the basics requirements manually and then you have people expanding the services a pharmacist can offer.  We see this second group relying more and more on technology to achieve their goals.

CT: What do you see as the near-term future of clinical and patient services?

Zage: Part of my involvement with the University of Illinois National Advisory Board is curriculum development. We have been developing a set of classes that we call R-Pharm, or rural pharmacy. This is an area where there are tremendous challenges associated with access to care. In rural areas, the closest pharmacy might be 50 miles away. Your primary care resource might be one doctor. So we are developing a curriculum to prepare pharmacists to be involved as a part of the care process in rural areas.

I also am interested to see the development of practices that, for example, tie in the services a nurse practitioner with the expertise of the pharmacist at an easily accessible retail site. I believe the level of care you will receive in this setting - as well as the accessibility of this care - is very valuable for a patient.

In all these cases, the question then is, how does the pharmacist take care of the basics, like filling and verifying/checking prescriptions, and also have time to participate in a personal care offering like I just described?

CT: What's your vision for Kirby Lester's role in supporting pharmacists looking to develop innovative service models?

Zage: We will continue our efforts in developing lower-end technology requirements that support the basics of pharmacy: get the right drug to the right patient 100% of the time. Our goal at Kirby Lester is to be part of automating all aspects of dispensing, while accounting for both accuracy of drug selected and count. And we want to do this in such a way that it's affordable. We recognize that it's not a one-size-fits-all world. It's important for pharmacists to have the right piece of technology. Since late 2005, we have worked hard to develop four brand-new products that can support the pharmacy doing 75 prescriptions a day all the way up to 1,000 a day, with the national average around 225 a day. We want to keep it simple and affordable with robust functionality available for those who want it.

CT: Garry, thanks for taking time to share your thoughts. Any final comments?

Zage: My pleasure.  I think when you look at the trends, they are all leading toward more involvement in healthcare by the pharmacist. I'm talking about trends toward addressing healthcare costs, the costs of non-compliance, and the current thinking about how we can better utilize the pharmacist as truly part of the healthcare team.  The question is then, how do you bring pharmacists in as a provider of care that makes sense for the healthcare issues we see in the United States? How do we address non-compliance? How do we look at medication therapy management programs so that they make sense for the patient and for pharmacy as a profession? How do you factor all this in? Overall, I think pharmacy has reached a major transitional point where there are great, great opportunities. We are here to listen and continue to develop technologies that fit and support the profession and practice of pharmacy.