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."
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.
Within 12 weeks, InstyMeds was dispensing half of
all prescriptions at Richardson's clinic. "People who use
it once ... consistently want to do it again," says Richardson,
who had been skeptical that it would work.
A few other companies, including e-prescribing pioneer
AllScripts, are pursuing doctor-based drug dispensers, but none
are as fully automated, says Bruce Scott, past president of the
American Society of Health System Pharmacists.
It's not perfect. The poor and ER patients may not
have credit cards. And while InstyMeds can store up to 80 different
medications, stock customized to each office's prescribing habits,
it can't carry everything.
Plus, pharmacists have special 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.
Minnesota's pharmacy board praised the bar-code system
as a way to ensure patients get the right drug.
Armed with board approval, Rosenblum's Mendota Healthcare
Inc. is negotiating to place InstyMeds in additional doctors'
offices and emergency rooms. Some drugstores are also considering
if automating easy-to-fill prescriptions could free pharmacists
for more important work, like counseling. Users would hire Mendota
to provide and stock the machine, at cost of a few dollars for
each prescription filled.