ATM-style drug dispenser saves time, maybe errors

Tuesday, November 13, 2001

WASHINGTON -- It looks like a giant ATM machine, but instead of cash the contraption at a Minneapolis pediatricians' office spits out prescription drugs.

No more treks to the drugstore for a 45-minute wait with a sick child: Just insert the prescription and a credit card, and out pops the medicine.

InstyMeds is the first automated prescription drug dispenser to hit a doctor's office, the latest in a trend toward computerizing prescriptions to cut not just drugstore lines but dangerous errors.

So far, InstyMeds is a pilot project. But Minnesota's pharmacy regulators just approved its use anywhere in the state, and the inventor hopes eventually to place the dispensers in doctors' offices and emergency rooms around the country.

The question is how best to use this technology -- as convenient one-stop-doctoring for the insured middle-class, or to cut the workload of pill-counting pharmacists so they have time to teach patients safe medication use.

Dr. Ken Rosenblum, a former emergency room physician, had the idea while hunting in a late-night pharmacy for antibiotics for his 5-year-old's ear infection.

"I thought, 'This is crazy. ... Why do we get our health care at two places?'" Rosenblum said. "If you went to a restaurant and the waitress gave you an order slip and said, 'Now drive 2 miles away and wait an hour for your food,' we wouldn't do it."

Unfilled pharmacist posts

Americans have doubled prescription drug use since 1989, yet the number of pharmacists remains about the same. Drugstores report about 12,000 unfilled pharmacist positions. That means fewer late-night, holiday or 24-hour pharmacies -- even some emergency rooms have closed outpatient pharmacies -- and longer lines.

Worse, prescription errors are blamed for 7,000 deaths a year. Among the causes are illegible prescriptions and slipups by overworked pharmacists.

To help, many hospitals now use bar-coded drug stocks for inpatients to ensure they get the right drug. And about 4 percent of doctors use Palm Pilot-like electronic prescription pads, eliminating the handwriting problem and allowing a quick records check to ensure that a new prescription won't interact dangerously with a patient's current drugs.

InstyMeds combines those computerized safety systems to let patients buy their prescriptions at the touch of a few buttons.

First to use it: a South Lake Pediatrics branch in suburban Minneapolis. Dr. Keenan Richardson and five colleagues write e-prescriptions. They type in the child's weight and the pad automatically calculates the right dosage, eliminating another opportunity for an error.

Parents get a prescription printout with a security code to type into InstyMeds. The computer verifies the prescription and checks insurance records. A credit card is swiped for the co-pay.

Inside the machine, a bar-code reader picks a bottle with the right dose and amount of medicine, slaps on the instruction label, and out it pops.

Has limitations

It's not perfect. The poor and ER patients may not have credit cards. InstyMeds can store up to 80 different medications, but it can't carry everything.

Plus, pharmacists have expertise in counseling patients on safe drug use -- and drugstores can track prescriptions from different doctors to block dangerous medical interactions, adds Matthew Grissinger of the watchdog Institute for Safe Medication Practices.

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