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Hi everyone. Welcome to a Becker's podcast.
On the line with us is Scott Ji.
He is an amazing pharmacy expert.
I'm really excited to get his thoughts on the expert space. Um,
we're just gonna go ahead and start diving in. Scott,
could you please introduce yourself and tell us a bit about your background?
Uh, yeah. Hi, I'm glad to be here. My name is Scott Epci.
I am the current director of Pharmacy Cancer care services at the Mayo Clinic in
Rochester, Minnesota. Uh,
which basically means I oversee the oncology service line at,
at the Rochester campus in Mayo, at Mayo. Uh,
and then I coordinate oncology pharmacy services across the enterprise where
we're trying to get everything aligned and, and doing it about the,
the same way wherever we can. Um, I'm a hospital pharmacist, uh,
by training.
I'm one of those pharmacists that got a bachelor of science back in the
eighties. I worked a few years in hospitals,
went back and got my doctor of pharmacy degree, did a residency fellowship,
and I have had a breadth of experience, uh, academia, uh,
clinical practice. I did a little bit of industry and then, uh,
about 15 years ago,
made a decision to go into pharmacy administration and really have been focusing
on the administrative side of oncology care. And so that's where I am now.
I've bounced around, worked at Yale New Haven for a while,
director of Pharmacy in Austin, Texas for a while now.
I'm here at Mayo and I'm loving it here.
Great, great. I'm glad you're loving it at Mayo.
What opportunities or headwinds, uh, do you kind of have your eye on right now?
Yeah, I am, I'm really intrigued with ai,
whether you call it in augmented intelligence or artificial intelligence
or whatever. Uh, a lot of what pharmacists do,
particularly on that operational side,
that order verification side is pattern recognition.
And I really think we're gonna get to a point where the pharmacist doesn't have
to do as much work. If the thing is normal, everything looks good,
there's no changes to the order, uh, it meets the criteria.
It just flows all the way through.
And then the AI flags us to be looking at those exceptions. And, you know,
this, this is something you should take a look at, kind of thing.
And what I'm excited about then is it begins to get us to that point where we
wanted to be for several decades now of let's get you
out in front of the patient,
let's have the pharmacist face-to-face with patients, uh, shoulder,
shoulder with providers in the clinics. Um,
we're starting to do this here at Mayo where we're getting more and more people
into the clinic.
And I think it's really got opportunities and we're finding that pharmacists can
really help things in the clinic to become more efficient.
Uh, we find when the pharmacists actually are doing the chemo orders,
the number of changes we have to make on the backside is less, uh,
when the pharmacists are managing some of the toxicities and side effects, uh,
patients do a little better.
And those are the kind of things we're really excited about and want to get out
and do. Uh, the other thing I'm real interested in is, uh, robotics.
We've installed our first chemo compounding robot here at Mayo Clinic.
It's doing roughly 20% of our mixes, uh, every day. Uh,
and again, the question is,
could we get to the point where we don't have to have a human hands
touch these hazardous drugs? And I think that would be beneficial to everybody.
And and I don't think it's gonna replace people.
What I think it's gonna do is free people up to become more efficient, uh,
work, uh, work smarter, not harder, those kind of things.
And so I'm really excited about where we're gonna be over the next five or six
years. I think some of the roadblocks,
all of this is there's some cost involved.
There's a lot of regulatory barriers we're gonna have to overcome. Uh,
there's a lot of, of, that's the way we've done it kind of attitudes,
particularly at the regulatory level. Uh,
and we're gonna have to work through some of these to show that these things are
safe, efficient in the way to go. So I,
I think it's a fun time to be a pharmacist,
fun time to be a pharmacy administrator as you're starting to put things
together to say,
what can we do to become more efficient and show more value to people.
I understand the, I'm really interested in the, uh,
robot than you mentioned. Of the 20% of mixes every day,
you said it's the first chemo.
It it's the first chemotherapy compounding robot in the state of Minnesota. Now,
there, there are others across the country. We're not the first in the country,
but uh, we're the first in the state of Minnesota. Um,
and so it's set up that it will actually compound the chemotherapy for us.
Uh, so the technician loads the robot with the appropriate supplies,
and then the robot uses barcode technology, optical scanning,
uh, graver metric weighing and actually prepares the chemotherapy,
uh, and is very, very accurate. Uh, the, the number of rejections is very,
very tiny. Uh, and so it's,
it's one of those things we really think are safe and effective and it frees our
technician.
They can load the robot and then they can go off and do something else while the
robot's compounding. You know,
those are the kind of things that we really like to see more and more of as we
go. The question is how do we make the robots more efficient also, um, you know,
it it, can we get to the point where we're doing 50% or something like that.
That's where we'd like to be over time.
And how far or close in the future do you think that, you know,
20% to 50% changes?
Uh, I don't think it's as far off as we think it is. Uh, we've seen some,
some demos at some of the,
the national meetings of robots that are doubling the volume,
the capacities that we do now. Um,
and I think it's just getting those robots to market,
getting 'em in and set up and ready to go. Uh, and then I,
I suspect there's another wave coming behind that. And so there,
there's gonna be a diminishing return,
there's gonna be a point where it can't mix any faster that physically. Uh,
but I think, uh,
how do you build these robots where you've got multiple arms doing multiple
things at the same time and it makes it an efficient process to
move the drugs through the system. Um, again,
the faster we compound things, the faster we get drugs out the door,
the faster we can treat patients and maybe we can move that patient
through the system just a little bit quicker.
And if we do that for all of the patients that come in today,
maybe we treat more patients and we have better access, that kind of stuff.
That's the long-term goal when we're trying to make the clinic more efficient.
You also mentioned kind of regulatory, uh, barriers and,
you know, an attitude of, well, that's the way we've always done it.
Can you kind of delve more into, you know,
what might kind of halt or pause these advancements?
There are regulatory boards like the Board of Pharmacy,
those kind of things that are reluctant to make
radical jumps because they're concerned with safety,
population safety, et cetera. Um,
and so what you have to do whenever you're making these technological jumps
is show to the regulatory agencies,
this process is safe. We can do this process as well,
if not better than if a human does it and prove to them that
these systems work. It takes time to do that.
And so when you're sitting there talking to someone who's never seen a robot
before, try to do the work, you're, you're having to,
you're having to explain to them, this is effective, this is safe,
this is not something we have to worry about.
And then sometimes you even have to go to the legislators to get the laws
changed because there's a law that may prevent you from doing that.
All of that process takes time. Um,
and it's just one of those things that we have to,
we we're constantly having to deal with and healthcare as
technology evolves, I think one of the,
one of the issues we're facing right now is technology is evolving faster than
the regulatory and policy agencies can keep up with.
And so we're just gonna have to work through those processes over time.
Eventually they'll come around,
eventually the law will change or the re regulatory policy will change.
It's just gonna be able to show,
it's gonna require us to show that this is the appropriate change to make and
this is the appropriate time to do it.
And I'm sure many other hospital pharmacy leaders, um,
would like to see regular regulatory changes made soon. Um, you know,
if it is bringing up ISTs and pharmacy technicians times,
um, so they can work smarter, not harder, like you said, um,
could help kind of alleviate some of the workforce shortages, I'm sure.
Yeah, and unfortunately,
most pharmacies are regulated at the state level. So, you know,
across the country we almost literally have to do this 50 times.
You have to convince each state that this is the right thing to do.
Now there'll be a momentum, there'll be a wave as more and more people,
and then more and more states adopt it. It gets easier for the, the, the,
the later states to adopt it. But if you're sort of in that front waiver,
so sometimes it takes you a while to get things changed, to get things adopted,
get things ready to where you want them to be.
Right, right. Um,
just to kind of move it out of the robot AI topic for a bit,
you said it's a fun time to be a pharmacy administrator right now.
Are there any other, um, kind of trends that excite you right now?
Um, I, I really, there,
there's a shortage of oncologists in the country right now. Um,
there's a shortage of oncology nurses.
There's a shortage of advanced practice providers.
So for me,
I'm sitting there thinking about what can a pharmacist do in clinic to provide
their clinical expertise on drug therapy to help
our pharma, our, our, our provider colleagues to reduce burnout,
to help them get patients through, to see more patients,
to do those things we need to do to meet the demands of a growing cancer
population. Um, cancer is a disease of old age,
and so as the population increases, as it gets older,
we're gonna see more and more cancer patients. So we've,
we've got this perfect situation set up where pharmacists can step in
and be almost providers,
primary providers or providers to help make sure the therapy is being
done, uh, appropriately. It's being done effectively.
And it really excites me to see what we can do from a pharmacy perspective as
we're put in these, uh, clinic positions. Um, I think it's gonna be very,
very interesting. Uh, we're also in that we're,
you know, we're starting that transition of moving from quantity to quality
and how does reimbursement follow that process? And that's a tricky,
that's a tricky situation as we start looking at changing reimbursement
models, evolution of, of the economics of cancer.
Uh,
and then you combine that with cancer drugs that are just skyrocketing in price.
Uh, we have to sit back and say,
what are we gonna do to show value to make sure this whole process works?
And to me,
I think pharmacy can shine with that because we can show value by making sure
we're using the right drug, right time, right patient,
and doing it in the right way so that we get the best outcome.
You put that all together, you're optimizing quality,
and when you optimize quality, then you improve the value to patients.
And that's something that we're really,
we're really looking at to try to optimize at this point in time.
Right, right. Something else that I wanted to kind of poke your brain about is
because of the, you know, pharmacy oncology angle, and there are a lot of, uh,
cancer drugs that I know are in pretty severe shortages right now. Um,
what, what are your thoughts on that?
Drug shortages have been a significant problem for the last decade,
decade and a half. Uh,
and they continue to be shortages just about the time you think you've reached
the point where you're not gonna have to worry about a shortage,
another one pops up.
And so we have constantly had to deal with drug shortages again over the last
10 to 15 years. And we're not, I would, I would say we're getting better at it,
but it is still a constant headache.
It's one of those things when you start talking about burnout in,
in healthcare providers, when you're constantly having to juggle,
can I treat this patient the way they needed to need to be treated?
Or am I gonna have to find an alternative because we can't get the drug,
that creates a significant, uh, significant pressure.
And that pressure leads to burnout.
And then particularly when you run into one of those severe shortages where
you're having to say, I can treat this patient but not that one.
And you're starting to have to decide, this patient's curable, this one's not,
I'm gonna give the patient this drug because that's the best use of the drug.
That's a tough situation to be in. It's a tough situation to put anybody in.
And, um, you know, at,
at Mayo we have a great team that stays on top of this.
And so we're,
we're trying to prevent getting into that situation to the best of our
abilities. Uh, but we're always worried about it. We're always looking at it,
we're always trying to figure out how do we stay ahead of the shortages. Uh,
and I think that's something that everybody across the country's having to deal
with. I wish there was a way to fix it,
and I don't know the way to fix it other than
incentivizing, uh, generic companies to make some of these cheaper drugs,
uh, and incentivize them by, maybe we have to pay more for them, uh,
which means then the reimbursement has to go up and all these other things.
But that may be the only way we can figure out how to make this process work.
While I still have you for a few more minutes,
is there anything else you'd like to add?
I, I just think that as oncology continues to grow, you know,
we're getting, we're getting better drugs, we're getting more treatments,
we're getting interesting drugs. Uh,
we're on the wave of cellular therapy and gene therapy.
I think it's a great time to be an oncology pharmacist because, uh, we get to,
we get to work with the cutting edge technologies, uh,
both on the drug side and now even on the technological side. Uh,
and we can be right there frontline to help patients.
And so it's one of those things that I'm excited to be an oncology pharmacist at
this point in time, and I think that's something that we can really,
really take a step forward in helping the overall value
to patients, the overall value to the institutions,
and ultimately the over overall value to society as we improve healthcare
globally across, you know, our country.
And I think that's one of the things that's really fun to think about as a
pharmacy administrator. And I think that's why it's fun to be, uh,
at this point in time.
Great. Well, thank you again so much for your time, Scott.
That's all we have for today. Um, yeah. Thank, thank you. Thank you. Thank you.
Really.
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