INTRODUCTION

Digital transformation in the healthcare sector, particularly in hospital pharmacies, has become a top priority for enhancing the safety and efficiency of medication management. Digitalization can make medicines safer, facilitate easier tracking of inventory, and expedite dispensing, ultimately improving the quality of care. Hospital pharmacies must have manage resources effectively to ensure that patients receive the correct medicines on time [1].

The urgency around digitalization in hospital pharmacy settings is growing because of persistent challenges in medication administration and rising service demand. Evidence shows that deploying automated systems throughout the distribution process can reduce patient waiting times and improve the accuracy of medication administration [2]. Furthermore, digital tools support inventory management by reducing the risk of stock shortages or overstock, enabling real-time stock monitoring, and minimizing waste [3]. Key performance indicators (KPIs), such as dispensing time, drug supply, dead stock, expired drugs, and medication errors, are crucial for determining the effectiveness and efficiency of digitalization in improving pharmacy operations [4].

Although numerous studies have examined digital transformation in healthcare more broadly, relatively few have investigated its specific impacts within hospital pharmacy environments. The literature still lacks comprehensive analyses that clarify how digitalization influences critical KPIs in these settings [5]. To fill this gap, structured studies are needed that not only measure the impact of digital technologies on pharmacy performance but also provide managers with evidence-based information to inform decision-making.

Numerous systematic reviews have examined the role of digital technologies in pharmacy services; however, most have been limited in scope, settings, or outcomes. For example, Batson et al. [6] and Shbaily et al. [7] evaluated automated systems for medication dispensing but did not consider technologies such as computerized physician order entry (CPOE) or barcode medication administration (BCMA). Meknassi Salime et al. [8] examined automation models, focusing primarily on clinical outcomes, while Nasution et al. [9] presented a descriptive overview of hospital pharmacy systems without a performance-based synthesis. Reviews by Alsoweih et al. [10] and Nwokedi et al. [11] assessed broader digital health adoption, but emphasized community or telepharmacy contexts rather than hospital-based operations. Zheng et al. [12] conducted a systematic review of closed-loop medication management technologies and their impact on workflows and safety; however, their analysis was limited to controlled substances and excluded broader operational or inventory-related outcomes.

To date, no comprehensive systematic review has integrated findings across multiple digital technologies—such as automated dispensing cabinets (ADCs), CPOE, BCMA, and robotic dispensing units—while concurrently evaluating their impact on dispensing efficiency, medication safety, and inventory management in hospital pharmacy settings. This review addresses that gap by synthesizing quantitative, performance-based outcomes using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided methodology, thereby providing a unified framework for understanding the operational value of digital transformation in hospital pharmacy practice.

This article focuses on dispensing efficiency, medication safety, and inventory management to examine how digitalization influences KPIs in the hospital pharmacy environment. Through a comprehensive systematic review, we aim to advance the knowledge base in pharmacy management, identify areas requiring further research, and provide practical insights for healthcare stakeholders and pharmacy installation managers seeking to enhance the quality of pharmaceutical services [13].

METHODS

Study Design

A systematic literature review was conducted to evaluate the impact of digital tools on hospital pharmacy operations. This review followed the PRISMA 2020 guidelines [14].

Search Strategy

A comprehensive search strategy was employed to identify publications related to digitalization in hospital pharmacies, with a focus on dispensing efficiency, medication safety, and inventory management. The search strategy incorporated keywords such as “pharmacy,” “pharmacy department,” “hospital pharmacy,” “digitalization,” “electronic system,” “automation,” “dispensing time,” “drug availability,” “death stock,” “expired drugs,” “medication error,” and “procurement accuracy.” Extensive literature searches were conducted across Web of Science, PubMed, and Scopus. Detailed search strings for each database are provided in Supplemental Material 1.

Eligibility Criteria

This review included original, peer-reviewed research articles published in English between 2014 and 2024. Eligible studies were conducted in hospital settings—specifically general hospitals, academic hospitals, or tertiary-level institutions—and investigated the use of digital technologies in pharmacy operations.

For this review, digital technologies were defined as hardware or software systems designed to support medication management processes within hospital pharmacy settings. Studies were considered eligible if they evaluated at least one of the following categories: (1) Automation technologies, such as ADCs or robotic dispensing systems; (2) Digital systems, such as CPOE, electronic prescribing (e-prescribing), or pharmacy information management systems; (3) Hybrid solutions integrated platforms combining hardware and software, such as ADCs with barcode verification systems; (4) Eligible studies were required to report outcomes in at least one of the following domains: (i) Dispensing efficiency (e.g., prescription processing time, patient wait time), (ii) Medication safety (e.g., dispensing error rates, misidentification incidents), and (iii) Inventory management (e.g., drug availability, expired stock, stockout rates).

Studies were excluded if they met any of the following conditions: (1) Conducted in non-general hospital settings, including psychiatric hospitals, rehabilitation centers, military field hospitals, or specialized care institutions (e.g., oncology-only or infectious disease hospitals); (2) Focused primarily on community pharmacies, standalone outpatient retail services, or ambulatory care centers not integrated into hospital-based pharmacy services; (3) Investigated experimental or prototype technologies that had not yet been implemented in real-world hospital operations; (4) Did not report quantitative performance outcomes related to medication dispensing, safety, or inventory management; (5) Were not published in English, did not provide full-text access, or were published in non-peer-reviewed formats (e.g., conference abstracts, editorials, reviews, or opinion pieces).

These inclusion and exclusion criteria were applied during the title/abstract and full-text screening stages to ensure that only empirical, practice-based studies conducted in real hospital environments were incorporated into the analysis.

The decision to include only English-language, open-access articles was made to ensure that all selected studies could be retrieved in full and critically appraised by the review team without institutional subscription barriers. While this restriction may have excluded relevant studies in other languages or subscription-only journals, it enhanced the transparency and reproducibility of the review process. Additionally, experimental or prototype technologies were excluded, allowing the study to focus solely on technologies that had been fully implemented in routine hospital pharmacy operations. This approach makes the results directly applicable to real-world practice.

Study Selection Process

The study selection process followed PRISMA 2020 guidelines. Two reviewers (EPBA and DE) independently screened the titles and abstracts of all articles retrieved from the databases. After the initial screening, full-texts were assessed for eligibility based on the predefined criteria. Disagreements during screening were resolved through discussion and consensus. Any remaining disagreements were resolved by consultation with Satibi (S). A total of 319 records were identified. After removing duplicates and applying the eligibility criteria, 68 full-text articles were assessed, of which 7 met the inclusion requirements. An additional 2 studies were identified by hand-searching, resulting in 9 articles included in the synthesis. The process is summarized in the PRISMA flowchart (Figure 1).

Data Extraction

Data were extracted independently by 2 reviewers (EPBA and DE) using a standardized form. Extracted variables included study characteristics (author, year, country, setting, design), type of digital technology, implementation details, and reported outcomes related to dispensing efficiency, medication safety, and inventory management. Discussions or consultations with a third reviewer (S) were used to resolve disagreements. The extracted data were summarized in tables and synthesized narratively.

Quality Assessment

The methodological quality of the included studies was evaluated using the relevant Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Two reviewers (EPBA and DE) conducted the appraisal independently, and disagreements were resolved by consensus or by involving a third reviewer (S). Studies were not excluded based on appraisal results; instead, quality ratings were reported Table 1 [15-23] to aid interpretation of the findings (Supplemental Material 2).

Statistical Analysis

A narrative synthesis was performed to summarize the evidence across studies, identify patterns in the impact of digital technologies, and highlight implementation challenges. The analysis was structured around 3 core domains: dispensing efficiency, medication safety, and inventory management.

Ethics Statement

This study is a systematic review using published secondary data and does not involve human or animal subjects.

RESULTS

Quality Assessment of Included Studies

The included studies largely met the essential quality standards set by the JBI [24]. However, some methodological gaps were observed, including insufficient data on confounding factors and inadequate follow-up, particularly in implementation case reports. Despite these issues, the studies provide valuable insights into how digital technologies affect hospital pharmacy operations. Detailed quality appraisal results using the JBI checklist are provided in Supplemental Materials 2 and 3.

Overview of Included Studies

A total of 9 studies were included in the final synthesis, conducted in Saudi Arabia, the United States, Denmark, Iran, Jordan, Australia, and France. These studies employed diverse designs, including retrospective reviews, prospective observational studies, and implementation reports. The digital technologies evaluated encompassed ADCs, e-prescribing, CPOE, BCMA, and hybrid systems integrating multiple technologies. The studies varied in scope, sample size, and setting, reflecting the heterogeneity of digital pharmacy implementation across hospital contexts, as summarized in Table 2 [15-23].

Dispensing Efficiency

All included studies reported outcomes related to dispensing efficiency. The use of ADCs in inpatient wards led to an 83% reduction in medication administration time [15]. Adoption of a thrice-daily medication cart-fill process reduced the number of prepared oral doses by 32.7% and cut medication lead times by 55% to 65% [16]. Implementation of robotic dispensing units in outpatient pharmacy services decreased patient waiting times and lowered the dispensing error rate from 1.00% to 0.24% [18]. Integration of ADCs with barcode verification systems reduced the time required for medication preparation, contributing to faster and more accurate medication distribution [22].

Medication Safety

Digital technologies were also associated with improvements in medication safety. In a Danish acute medical unit, the implementation of a complex automated medication system including automated dispensing and BCMA significantly reduced medication administration errors [17]. In outpatient settings, electronic prescribing was associated with 631 medication errors versus 3714 under paper-based system [19]. A combination of CPOE, ADCs, and automated packaging systems demonstrated positive impacts on medication safety, although specific error reduction percentages were not reported [20]. Barcode verification technology integrated with electronic inventory systems also enhanced dispensing accuracy [22]. ADCs equipped with reverse logistics processes contributed to safer drug use and lower medication return rates [23].

Inventory Management Outcomes

Inventory-related metrics were discussed in 4 studies, covering stock control, expiry reduction, and drug availability. A 20% decrease in expired medications was reported after implementing ADCs [15]. Improved stock rotation and a decrease in expired stock were observed with the use of automated systems [18]. Real-time inventory tracking through ADCs decreased stock-outs by 35% [19]. Improved ordering accuracy and reduced overstocking were achieved through better inventory reports generated by automated systems [16].

Supporting Indicators

Several studies also reported outcomes beyond the core performance indicators. Workflow speed frequently improved [15,16]. As a secondary benefit, staff satisfaction increased, with pharmacists and technicians reporting less manual work and greater accuracy [18]. In a hospital survey, 87% of nurses believed ADC implementation improved medication delivery efficiency [23]. Robotic systems were associated with increased patient throughput, enabling more prescriptions to be processed in less time [18]. Better traceability via barcode systems and greater adherence to medication delivery standards further enhanced workflow and patient safety [22].

Negative or Neutral Findings and Implementation Challenges

Although most of the included studies (Tables 3 and 4) [15-23] reported improvements in efficiency, safety, and inventory management, several also described neutral or unfavorable results, as well as implementation-related operational challenges. These findings are summarized in Table 5.

Robotic dispensing units were found to reduce dispensing errors and patient wait times, but they required substantial staff training and caused temporary workflow disruptions [18]. Electronic prescribing systems lowered error rates compared with paper-based prescriptions but were vulnerable to system downtime, which at times necessitated temporary reversion to paper methods [19]. Barcode verification enhanced dispensing precision; however, its efficacy depended on consistent user adherence, which occasionally declined under time pressure [22]. Comprehensive, integrated drug-management systems improved efficiency but faced issues with interoperability and infrastructure requirements [20]. Complex automated medication systems reduced medication administration errors but did not significantly impact broader clinical outcomes [17]. ADC-enabled reverse logistics reduced expired stock and medication returns, yet effectiveness depended on nursing compliance [23]. ADC optimization improved inventory turnover but produced only modest cost savings, and required ongoing oversight [21].

DISCUSSION

This systematic review examined the impact of digital technologies on the efficiency, safety, and inventory management functions of hospital pharmacy services. The findings demonstrate that various technologies including ADCs, e-prescribing systems, CPOE, and BCMA, yielded positive outcomes across the 3 domains of interest. Notably, ADCs were strongly associated with reductions in dispensing time and expired stock [15,16,18,22]. In contrast, e-prescribing and barcode systems were effective in minimizing medication errors [17,19,20,22,23].

Several studies have reported substantial improvements in workflow efficiency, with dispensing times reduced by as much as 83% in one study following ADC implementation [15]. These results align with earlier reports from high-income settings linking pharmacy automation to streamlined medication distribution processes and improved staff productivity [6,12,15,16,18,22]. Our review contributes to this body of evidence by incorporating studies from diverse healthcare systems, including those in middle-income countries, suggesting that these tools are applicable across a broader range of settings.

Multiple studies documented improvements in medication safety, including fewer prescribing and administration errors [17,19,20,22,23]. These findings support the role of BCMA and CPOE in improving clinical accuracy. For example, after the adoption of e-prescribing, one study reported a reduction in medication errors from 1.30% to 0.24% [19]. These results are consistent with separate research indicating that electronic systems may reduce preventable medication errors in hospital settings [6,12]. Notably, this review extends the literature by demonstrating similar safety gains in real-world implementation contexts rather than controlled experimental designs.

Inventory management outcomes, although reported in fewer studies, suggest that automation can significantly reduce expired drugs, improve stock rotation, and lower the incidence of stockouts [15,16,18,19,21,23]. This supports the view that digital technology optimizes the financial and logistical performance of pharmacy departments in addition to improving clinical operations. For example, Almalki et al. [15] reported a 20% reduction in expired medications following ADC implementation.

Despite the predominantly positive outcomes observed, the included studies demonstrated substantial variability in study design, scope of implementation, outcome measures, and healthcare settings [15-23]. Some were restricted to descriptive implementation reports, whereas others used rigorous quantitative approaches. This variability limited the generalizability of the findings and made direct comparisons between technologies or contexts more difficult. Nonetheless, the overall direction of the data is reinforced by the consistent positive trends across various settings.

At the same time, several studies reported neutral or even adverse outcomes, along with operational challenges that may limit the effectiveness of digital interventions [17-20,22,23]. Commonly reported barriers included the need for extensive workflow adaptation, resource-intensive setup processes, and increased documentation during the initial adoption phases [15,16,18,20]. Technical problems were also identified as threats to sustained performance, including system outages, incompatibilities with existing hospital information systems, and reliance on reliable internet connectivity [18-20,22].

When interpreting these results, it is essential to acknowledge potential sources of bias. Publication bias may have favored studies reporting positive or statistically significant outcomes, while neutral or negative findings could be underrepresented. In addition, unmeasured confounding factors—such as concurrent policy changes, staff training initiatives, or infrastructure upgrades—may have contributed to the observed effects, making it difficult to attribute improvements solely to the adoption of digital technologies. Compared with previous systematic reviews that focused on single interventions (e.g., ADCs or e-prescribing) or specific geographic contexts, the present review adopts a broader scope by synthesizing evidence across multiple technologies and diverse healthcare systems. This integrative approach enables a more comprehensive understanding of operational impacts, while also introducing greater heterogeneity, which should be considered when formulating policy or implementation strategies.

Notably, some research indicates that gains in operational efficiency do not always translate into significant improvements in broader clinical outcomes, such as shorter hospital stays or lower patient morbidity [17]. Furthermore, the effectiveness of specific interventions—particularly automated dispensing systems and barcode verification—was highly dependent on consistent user compliance, which could be compromised during periods of high workload or time pressure [18,19,22,23]. These findings underscore the need for implementation strategies that address both technical and human factors to ensure the long-term success of digital transformation in hospital pharmacy practice.

Finally, several implementation-focused studies carried a higher risk of bias due to limited methodological transparency, the absence of comparator groups, or a lack of confounder adjustment [15-23]. As such, while the overall direction of evidence supports the benefits of digital technologies in hospital pharmacy, caution is warranted when interpreting the magnitude of their impact.

Limitations

This review has several limitations. First, the included studies exhibited substantial variability in design, scope, and reporting quality, precluding a meta-analysis. Second, many studies relied on before-and-after comparisons without control groups, increasing their vulnerability to bias. Third, our decision to include only English-language and open-access publications, while practical to ensure complete and transparent appraisal, may have resulted in the exclusion of other relevant studies. Introducing potential selection bias. Ultimately, despite the application of JBI critical appraisal techniques, the overall strength of evidence is moderate due to the prevalence of observational designs and the limited use of robust implementation science frameworks.

The restricted number of studies in this review inherently limits the generalizability of the findings. Variability in hospital size, healthcare infrastructure, and national regulatory frameworks across studies may affect both the feasibility and the magnitude of the reported impacts. Consequently, the applicability of these results to settings with markedly different resources or organizational structures—particularly low-resource hospitals—should be interpreted with caution.

Policy and Practice Implications

Hospital managers and policymakers should prioritize the adoption of digital technologies in pharmacy operations as part of broader health system modernization strategies. Successful implementation requires not only financial investment but also sustained leadership support, cross-departmental coordination, comprehensive staff training, and contingency plans for technical disruptions. Tailoring adoption strategies to local resources and workflow contexts will be critical to maximizing the long-term value of digital transformation in hospital pharmacy services.

CONCLUSION

This systematic review provides evidence that digital technologies—such as ADCs, CPOE, BCMA, and robotic dispensing units—can meaningfully improve hospital pharmacy performance in dispensing efficiency, medication safety, and inventory management. These interventions were associated with shorter dispensing times, fewer drug errors, and improved inventory control, including fewer stock-outs and less expired stock, across various healthcare settings.

However, the results also point to critical contextual constraints. Significant resources, staff training, and workflow adjustments were frequently required for implementation, and system outages, interoperability issues, and inconsistent user compliance posed ongoing threats to sustained performance. Furthermore, quantifiable improvements in broader clinical outcomes, such as patient morbidity or length of stay, were not typically observed despite operational gains.

Overall, integrating digital technologies into hospital pharmacy operations confers specific operational and safety advantages; however, their effectiveness depends on institutional preparedness, infrastructural capacity, and human factors. To measure long-term effects, assess cost-effectiveness, and identify strategies for overcoming implementation barriers, future studies should employ robust, comparative designs.

Supplemental Materials

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

This research was supported by the Indonesia Endowment Fund for Education (LPDP), Ministry of Finance of the Republic of Indonesia, through the Master’s Scholarship Program (grant No. LOG-14669/LPDP.3/2024).

Acknowledgements

None.

Author Contributions

Conceptualization: Abimanyu EPB, Satibi, Endarti D. Data curation: Abimanyu EPB, Satibi, Endarti D. Funding acquisition: Abimanyu EPB. Methodology: Abimanyu EPB, Satibi, Endarti D. Writing – original draft: Abimanyu EPB, Satibi, Endarti D. Writing – review & editing: Abimanyu EPB, Satibi, Endarti D.

Figure. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram of study selection.

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References

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