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Collation Delay Optimization using Discrete Event Simulation in Mail-order

Pharmacy Automation Systems

Conference Paper · May 2016

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Proceedings of the 2016 Industrial and Systems Engineering Research Conference
H. Yang, Z. Kong, and MD Sarder, eds.

Collation Delay Optimization using Discrete Event Simulation

in Mail-order Pharmacy Automation Systems
Haifeng Wang, Duaa M Serhan, Sang Won Yoon
Department of Systems Science and Industrial Engineering
State University of New York at Binghamton, Binghamton, NY 13902

Abstract

This paper presents a comparison among several order processing rules to reduce prescription collation delay in mail-
order pharmacy automation (MOPA) systems. The objective of this study is to determine the most efficient order
processing policy that reduces multi-description order collation time and increases system throughput. Collation delay
is the time which the first medication requires to wait until the last medication from the same prescription reaches a
specific station. As the collation delay increases, the system throughput will decrease due to the additional order wait-
ing time. A discrete event simulation model is developed to study the collation delay under different system settings.
It has been identified that the input sequencing rule has a great influence on collation delay. To optimize collation
delay, multiple dynamic prioritizing strategies are evaluated. Four performance measures were used to evaluate the
proposed sequencing rules, 1) collation delay, 2) work-in-process, 3) makespan, and 4) value added percentage. The
results show that the proposed order sequencing rules can significantly reduce system cost and increase the system
performance.

Keywords
Collation delay optimization, Discrete event simulation, Mail-order pharmacy automation system

1. Introduction
Prescription demand has been increasing significantly over the last decades. The annual amount of prescription orders
increased by 86% from 1994 to 2004 in the U.S. though the increase in population was 14% [1]. Mail-order pharmacy
automation (MOPA) systems promote the overall system efficiency by reducing drug counting errors and patient
waiting time, increasing flexibility and consistency of the system, in addition to strengthening patients drug adherence.
In a community or retail pharmacy setting, error rates have been documented at 4 out of every 250 prescriptions
dispensed [2]. High frequency of medication errors is a serious problem that calls for action to be taken by healthcare
organizations, federal agencies, industry, and patients. Collation delays are directly related to patient medication
safety, because the longer a prescription spends being filled, the greater the chance of an error occurring. MOPA
leads to savings on prescription dispensing and inventory holding costs, improving the drug safety and quality [3].
Many prescription operators, such as pharmacy chains, hospitals, and other healthcare systems, have applied MOPA
settings. In the last decades, most of the top twenty pharmacy chains in the U.S. and Canada have adapted MOPA or
are investing in one. A well-known pharmacy chain, Walgreens, has four MOPA systems in the U.S. and it is in the
process of expanding [4]. Another example, Costco Wholesale Corpor has seen a decrease in pharmacy processing
costs per prescription from the range of $4 to $5 to $0.05 to $1 after they implemented MOPA for their dispensing
operations [5]. Moreover, it was reported that the mail order pharmacy system helped patients adhere to the regimen
described to them [6].
The key processes of a MOPA system consist of 4 stages: 1) filling, where pills are counted and filled into vials, 2)
collation, where the same order group medications are collated together, 3) packing, and 4) sorting and shipment. In
MOPA, dispensed medications are transported to verification, collation, and packaging stations through a sequential
auto-conveying system. It was found that patient waiting time at a pharmacy could be more than 90 minutes on
average [7]. Due to limitations of space and costs in MOPA systems, patient waiting time can be an even bigger
problem. Moreover, many of the prescription orders contain multiple medications, and each medication must be
dispensed at a different station for safety and quality issues. Therefore, without proper scheduling for multi-description
 Wang, Serhan and Yoon
orders at MOPA systems, the order time delay can be extend from several minutes to hours. This issue highlights the
importance of developing order processing rules that are capable of minimizing collation delays and improving the
system performance.
Collation delay can be defined as the time length that the first medication requires to wait until the last medication
from the same prescription reaches a specific station (collation station). As the collation delay increases, the system
throughput will decrease due to the additional order waiting time. If the collation delays of orders are large, the entire
system could easily become a deadlock, since the first medication may block the conveyor system. Collation delays
depend on labor schedule, machine replenishment, planogram design and even the most on order sequencing rules. In
this research, the impact of different order sequencing rules is studied through evaluating the performance of collation
delays, work-in-process, makespan, and value added percentage. The multiple order processing policies are developed
and evaluated using a discrete event simulation model employing real MOPA system data.
The structure of the paper is organized as: The general construction of MOPA system and related collation delay
optimization methods in MOPA are reviewed in Section 2. Section 3 presents order sequencing rules and discrete
event simulation methods. Experimental results are discussed in Section 4. Finally, conclusions and limitations of the
work are conducted in Section 5.

2. Background of This Research

Generally, MOPA systems consist of several parallel auto-dispensing machines and manual filling stations to complete
the drug filling process. In practice, many prescription orders include multiple items, which are handled by different
stations. The time gap to collate all the items of one order together for final packaging and shipping becomes one
of the key factors that impacts the MOPA system performance. The MOPA collation delay problem was considered
as an extension of the order scheduling problem with multi-purpose parallel machines environment. In a model with
such characteristics, machines can process specific subsets of jobs, therefore, each job has a predefined set of eligible
machines. Multi-purpose machine scheduling, which is also known as scheduling with processing sets restrictions,
was proven to be NP-hard when the processing times are arbitrary[8, 9]. This case is common in situations where job
with special characteristics are assigned to certain machines [10]. As the job size increases, it is typical that meta-
heuristics outperform exact approaches in terms of efficiency and effectiveness for obtaining reasonable solution for
this NP-hard problem. Although several heuristics have been developed in attempt to solve this problem [10], but
these approaches are specific and difficult to be adopted in new systems. The collation delay problem in MOPA sys-
tem was first addressed as multi-objective optimization problem, which applied collation delays and makespan as the
first and second objective, respectively [11]. The model results were compared using four heuristic approaches, vec-
tor evaluated genetic algorithm (VEGA), multi-objective genetic algorithm (MOGA), non-dominated sorted genetic
algorithm-II (NSGA-II) and longest processing time (LPT) heuristic, the results showed that the NSGA-II provided the
best frontier. The same problem was also studied as fill time window problem [12–14]. However, the aforementioned
studies have several limitations. The large problem solved in the multi-objective optimization paper was 120 jobs,
which is still a small size compared to practical MOPA demand. Furthermore, the automated dispensing machines
were assumed to be identical disregarding drug contamination. Besides that, the setup time, machine breakdown, and
replenishment were not considered in the model. To overcome the limitations of the mathematical approaches, this
research applies discrete event simulation to optimize collation delay for a high volume MOPA system.

3. Methodology
To minimized order collation delays, three sequencing rules are purposed, 1) First enter prioritize, 2) First enter
prioritize, count finish first, 3) First enter prioritize & first dispense prioritize. The sequencing rules were evaluated
using discrete event simulation model which employ a real pharmacy demand data.

3.1 Simulation Model

In this study, a simulation model is developed for a MOPA system which has an average daily demand of 12,000
prescription. The demand has an average inter-arrival time of 0.10 minutes with standard deviation 0.99 minutes. The
system’s operation hours are from 7AM to 3PM. The simulation model is developed using Emulate3D edition Sim3D
Enterprise 2015. The model consists of 7 workstations: 1) automatic, semi-automatic, and manual filling stations,
2) collation stations, 3) automatic, semi-automatic, and manual packing stations, 4) sorting stations. The one item
prescriptions, which are filled automatically or semi-automatically, are packed at fully-automated pack machines. On
 Wang, Serhan and Yoon

Sorting Station

Auto
Pack
Station Semi- Manual
Auto Pack Pack
Station Station

Collation
Station
Auto Fill
Station

Manual Fill Station

Semi-
Auto Fill
Station

(a) MOPA system flow chart (b) Simulation model layout

Figure 1: Mail-order pharmacy automation systems simulation model.

the other hand, the multi-item prescriptions which have four or less item are packed at semi-automatic pack station.
Otherwise the multi-prescription items are packed at manual pack station. After packing, completed orders are carried
to sortation station for shipping.
In the model, those one-item prescriptions, either filled automatically or semi automatically, are assumed to be packed
at automatic pack stations. Those prescriptions, either consist of no more than four manually filled items or consist of
automatically/semi automatically filled items, will be packed at semi-auto pack station. If the prescriptions consist of
more than four items or include manually filled items in automatically or semi automatically groups, the prescriptions
will be packed at manual pack station. After packing, orders will be transfered to sortation station and waiting for
shipping. The process of MOPA system is given in Figure 1(a). Figure 1(b) shows the MOPA system simulation
model layout. The simulation parameters of interest were the processing time for each workstation. Based on the
analysis on the practical MOPA system, triangle distributions are applied to simulate the process times. Table 1 shows
the number of machines/workshops and related processing time at each station. The simulation model is run for 8
hours with 2 replicates for each rule.

Table 1: Number of machines/workshops at each station and its processing time T(min,max,mode).

Stations No. workstations/machines Distribution Processing time (sec.)

Auto fill 5 Triangular T(28.9, 40.9, 35.43)
Semi-auto fill 1 Triangular T(21, 28, 24)
Manual fill 4 Triangular T(43.4, 120.4, 62.8)
Collation 2 Triangular T(6, 8, 7)
Auto pack 3 Triangular T(8, 12, 10)
Semi-auto pack 2 Triangular T(10, 12, 14)
Manual pack 3 Triangular T(20, 53, 40)

3.2 Order Sequencing Rules

Each prescription order is identified by group ID, which includes information about drug store code, patient identifica-
tion code, order date information. Each group order can contain several prescriptions and items. For example, a group
ID may include two vials Penicillin (2 items), three vials Aspirin (3 items), and one unit dosing cytotec (1 item).
A single order may contain one or several items, and each medication has its own medication conditions and filling
requirements. Thus, the items of one order can be processed by different stations with the MOPA system. The ideal
case for multi-items prescription is to reach the pack station at the same time with zero collation delay. However,
the complexity and uncertainty of MOPA system hinder is challenging this situation. Consequently, efficient order
 Wang, Serhan and Yoon
sequencing rules are required to be developed. The order sequencing rule determines the processing sequence and
priority of each order. In this study, four heuristic order sequencing rules, as shown in Figure 2, are evaluated:
First Come, First Serve (FCFS): Each drug category is assigned a sequence ID based on the order arrival time. The
items are filled according to their order arrival time. The earlier an order is received, the higher priority that the order
gets to be processed. The early received orders get higher priority to be processed. The later processes will also relay
on the sequence ID.
First Enter Prioritize: Once a medication (item) from an order group is released to system (start counting), the whole
group’s priority will be increased. The later process will also rely on the new priority, higher priority, first serve. This
strategy dynamically changes the original order sequencing, and the priority update process is also different from
traditional scheduling, since the sequence is generated during operation process.
First Enter Prioritize, Count Finish First: The first step of this strategy is the same as First Enter Prioritize, order
entering the system also relies on priority. However, in the later processes, instead of considering priority, only those
early finished orders will be released firstly to the next process. This strategy combines the first two strategies with the
difference in updating the priority of other items in one group. Also, only order entering process relies on priority ID,
the later processes are based on which order is first finished in the previous process.
First Enter Prioritize & First Dispense Prioritize: In addition to increase the group priority at the order entering
point, the order group priority will be further increased when any order in the group starts dispensing. The later
processes also rely on the new priority, higher priority, first serve.

Figure 2: Order sequence prioritization rules.

4. Experimental Results and Analyses

To compare the four order processing rules, a demand distribution based on the analysis of one year demand from a
MOPA system is applied. The demand for the one year data set is around 4,000,000 orders. Demand percentage for
each station in MOPA system is shown in Figure 3. The collation delay results are compared using various performance
measures, which are presented in a statistical view.
Four performance measures are used to evaluate the performance of the four sequencing rules;: 1) collation time
window, which is the time difference between the first and last items within one order reach collation station, 2) Work-
 Wang, Serhan and Yoon

Color legend
Start
Decision point
N Y Manual
Require Manual Fill?
Auto station
Require semi-auto fill? 19.88% groups
15.65% items Semi-Auto station
10.49% groups Y 76.89% groups N
Collation
8.23% items 76.12% items
Semi-Auto Fill Auto Fill
Manual Fill

Single item? Mixed fill orders?

63.40% groups Y N N
44.72% items 20.28% groups
Y
Y 37.96% items 3.99% groups 16.23% groups
Require items from manual 3.36% items 12.29% items
fill? 2.29% groups
Collation 1.67% items
61.12% groups N
44.72% items Require items from Satisfy bag capacity?
18.67% groups N manual fill? Y
34.46% items Y
1.62% groups N
3.5% items
Satisfy bag capacity? Manual Pack
N 0.86% groups
3.61% items 4.85% groups
17.80% groups Y 16.23% groups
30.84% items 12.15% items
12.28% items
Semi-Auto Pack

End

Figure 3: Demand distribution in terms of total daily demand for stations in MOPA system.

in-Process (WIP), which measures the number of items waiting at collation station, 3) makespan for collated items,
which represents the difference between item’s packing and filling times, 4) value added percentage represents the
lean level of the process, which is calculated based on value stream map. Table 2 presents mean and 95% confidence
interval (CI) of mean for fill time window, WIP, and makespan, in addition to value added percentage.

Table 2: Performance results compsrsion for the four collation rules.

Collation delay WIP Makespan
Rules Value Added Percentage
Mean 95% CI Mean 95% CI Mean 95% CI
First come, first serve 1,249.0 [1,101.5, 1,396.4] 20.7 [20.3, 21.1] 878.0 [808.7, 947.3] 8.2%
First enter prioritize 245.7 [222.2, 269.3] 17.0 [16.5, 17.5 ] 314.1 [298.4, 329.9] 24.3%
First enter prioritize, count finish first 365.1 [332.4, 397.8] 15.0 [14.5, 15.3] 359.0 [341.29, 376.77] 24.4%
First enter prioritize & first dispense prioritize 243.0 [212.1, 273.9] 13.4 [13.1, 13.7] 311.1 [293.6, 328.6] 24.9%

Based on the simulation results, the three proposed sequencing rules have outperformed the FCFS rules when the
aforementioned performance measures are considered. And, the First Enter Prioritize & First Dispense Prioritize rule
has the best performance among all the sequencing rules in terms of collation delay, WIP, and makespan. The collation
delay is reduced by 80.3%, 70.8%, and 80.5% for second, third, and fourth rules, respectively, compared with FCFS
rule. Comparing the makespan for all the rules, the last three sequencing rules reduce the makespan for multi-item
orders by 17.9% to 35.3% over FCFS rule, which implies having less system delay. WIP at collation station for the
fourth rule is the lowest and decreased by 35.3% compared to the first FCFS rule.
From lean production perspective, the proposed three rules can get even higher value added percentage, which repre-
sents the elimination of non-value added process. These results show the advantage of the last three rules on increasing
MOPA system performance, as the item’s priority is changing through different stages during the order entering pro-
cesses.
 Wang, Serhan and Yoon
By taking into account the four selected measures, the First Enter Prioritize & First Dispense Prioritize rule is the most
efficient rules among all the purposed rules. However, the difference of collation delay between the second and fourth
rules are relatively small.

5. Conclusion and Furture Work

In MOPA systems, collation delay plays an important role in minimizing shipping cost, reducing waiting time, and
increasing system throughput. Over the past decade, several exact optimization and heuristic approaches were applied
to minimize collation delay and makespan. However, the performance of these method degrades as the MOPA system
becomes larger. In this paper, discrete event simulation model is developed to study the collation delay under different
order sequencing rules. Three sequencing rules are purposed, 1) First enter prioritize, 2) First enter prioritize, count
finish first, 3) First enter prioritize & first dispense prioritize. The basic idea of these rules is to change the priority
of items during order entering process in order to reduce the collation time gap between the items within one order.
The three rules are compared with FCFS rule. Collation delay, WIP, makespan, and added value percentage are used
as performance measures to assess the effectiveness of sequencing rules. The results show that the three proposed
sequencing rules outperform FCFS rule, and the first enter prioritize & first dispense prioritize is the best rule among
all the rules.
However, there are still some limitations of this research. Instead of FCFS, different sequencing rules, such as shortest
processing time, earliest due date, etc. can be tested in the future. Also, the system layout, which may also have impact
on collation delay, is not specifically considered in this paper.

Acknowledgements: This study was supported by the Watson Institute of Systems Excellence (WISE) at Binghamton
University and by Innovation Associates. The authors also thank several colleagues who have inspired and provided
valuable comments to improve this study: Lashier, A. from Innovation Associates and Poch, L. from WISE.

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