MEDICINE Vending machine speeds up filling of prescriptions

New vending machines dispense prescription medicine away from pharmacies.
ST. PAUL, Minn. -- The last thing Mattie Franklin of Minneapolis wanted to do was wait in some drugstore for her prescription to get filled.
Franklin felt ill in late October, so she went to the emergency room at Abbott Northwestern in Minneapolis. She was diagnosed with a cold and bronchitis.
After prescribing medication on a handheld electronic device, her doctor asked if she would like to get the drugs at a pharmacy or at the new machine in the ER's waiting room.
She chose the machine. She was handed a voucher with a security code and took it to InstyMeds, which looks like an oversized automated teller machine.
After a few steps, including typing the security code numbers from the voucher onto the keyboard, her prescription dropped into the machine's bin.
"I'll get better in my own bed -- instead of waiting for my prescription in a chair at the drugstore," Franklin said.
Ken Rosenblum, a former emergency room doctor from Mendota Heights, Minn., developed the InstyMeds machine.
He launched a company, Minnetonka, Minn.-based Mendota HealthCare, to develop the drug-dispensing machine. The result is a sophisticated system in which an Internet-based electronic system processes insurance and billing information and then a robotic bar code-scanning device picks out and dispenses the right prescription -- all in a few minutes.
Rosenblum argues his new machine will allow sick patients to avoid the hassle and delay of getting prescriptions filled at stores -- especially at times and in places where it's tough to find an open pharmacy counter.
"Some people don't have transportation, so they don't get their medicine," Rosenblum said. He cites studies that conclude that a quarter of all patients, especially in urban emergency rooms, don't bother to get their prescriptions filled.
Given the boom in prescriptions, combined with a growing shortage of pharmacists, Rosenblum thinks he's introducing his machine at the right time.
While prescriptions have gone up 50 percent to 3 billion in the United States during the last five years, there are about 12,000 unfilled pharmacy positions nationwide.
The machine also dovetails nicely with another pharmacy trend -- electronic prescriptions. By eliminating the physician's handwriting as a potential source for error, electronic prescriptions could speed up the process for spotting drug interactions, checking insurance coverage and processing claims.
However, some pharmacists worry that their role in screening drug interactions and reviewing a patient's condition and drug history will be short-circuited -- to the detriment of the patient. A lesser concern, they say, is that the machines could siphon off sales or reduce demand for pharmacists.
The InstyMeds machine has a robotic arm with an attached bar-code scanner that searches through 80 slots for the right drug, dosage and amount specified by the prescription.
High-speed Internet connections link the machine to Mendota HealthCare's central system, which receives the orders and transmits labeling and billing information.
After the bar codes are checked three times, the machine applies a label on the box or bottle and drops it into the bin. The machine can typically handle up to 95 percent of everything any given doctor will prescribe, Rosenblum said.
"We are 100 percent assured of its safety," said Bruce Scott, a licensed pharmacist who is vice president of Allina Hospitals chain's resource management.
Potential problems
But filling the prescription incorrectly isn't the only potential source of error in the system, says Stephen Schondelmeyer, a professor of pharmacy at the University of Minnesota and director of its PRIME Institute.
In fact, misused and incorrectly prescribed drugs cost about $180 billion a year in wasted drugs and additional medical treatments, he said.
"A machine doesn't talk to the patient about their drugs, why they're using them or whether or not they are working," Schondelmeyer said.
He is particularly concerned about plans to install the machines at discount stores, especially if there would be no one to answer patients' questions.
Johnson adds that the increasing fragmentation of the drug delivery process -- patients getting their drugs from machines, through the mail, as samples from their doctors -- means no one is overseeing the patient's drug regimen for dangerous interactions.
But Rosenblum said there are fail-safe measures in the InstyMeds process. The prescribing physician checks the patient's list of other drugs, and the InstyMeds system can pinpoint potential interactions.
InstyMeds has a 24-hour call-in telephone line attached to the machine so that a patient can contact a pharmacist.

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