Doctor's Office ATM
Rx Vending Machines
By Jean Lawrence
Reviewed By Michael Smith
The advantages of getting your medication from the doctor's office are obvious. Either you're sick and don't fancy sitting around a drafty drugstore or crowded supermarket waiting for your prescription -- or you're herding a slew of sick or cranky kids and would just like to go home.
Enter InstyMeds and FirstFill, two systems that allow commonly prescribed drugs to be distributed right from a doctor's front desk or waiting room.
Ken Rosenblum, MD, CEO of Mendota Healthcare in Minneapolis, is the creator of InstyMeds. He says the idea of not having to leave the doctor's office without the drugs hit him when he came home late one evening. He had to go out again and roam the city looking for a pharmacy to get a medication his wife had been too busy to pick up for their 5-year-old.
"This is crazy," he recalls thinking that night. "Why do we have to get our healthcare in two places?"
Rosenblum also learned that drugstores were facing a severe pharmacist shortage and that many pharmacists would prefer to be counseling patients and collaborating with doctors on care plans rather than spending their time on the old, "count, lick, and stick."
The result was InstyMeds, a soda-machine-sized unit stocked with common medications that sits right in the doctor's waiting room.
No More Sloppy Handwriting
How does InstyMeds work? When you're ready to leave the office, your doctor describes the medication you'll take, explains how to take it, lists side effects to watch for, and asks you about any drug allergies you may have. Your doctor then writes the prescription on an electronic device like a Palm Pilot that uses the InstyMeds software. The system calculates the right dose based on your weight.
At this point, the doctor also asks, "Do you want to take this to your drugstore or would you like to pick it up outside on your way out?" According to Rosenblum, half of all patients choose to get the medicine immediately. If that's what you want, your doctor prints a voucher with a security code instead of a printed prescription, and you then insert the voucher into the InstyMeds dispenser.
The machine holds about 35 different commonly prescribed medications that are available in different strengths and quantities (but none that contain controlled substances). The voucher information comes up on the machine, and if you have a copay or are paying for the whole thing yourself, you use a credit card to take care of the fee. The prescribed drug passes through three barcode checks and rattles down just like a soda or candy bar, neatly labeled with your name and particulars about the medication.
When the machine starts to empty, it automatically reorders supplies. "Our idea is to make this as easy as possible for the office staff," Rosenblum says. "If this slows the doctor down, it will be a nonstarter." Doctors also make a commission on each prescription.
"It's very accurate and simple to use," says Keenan Richardson, MD, a doctor with the South Lakes Pediatrics practice in Excelsior, Minn., the first office to try InstyMeds. "There are no legibility issues. I kept checking the [automatically calculated] dosages at first, but I never found an error."
A similar system, called FirstFill, has been around longer than InstyMeds but requires the doctor's staff to reach for the medication bottle, merge the information with that in your chart, enter into a computer that you are getting the prescription and in what amount, and wait to hear back from your chart information whether you are allergic, and then print out a prescription label. The nurse also collects the payments. Or, FirstFill can send the prescription directly to the drugstore electronically. According to senior marketing manager Paul Peterson, the system is more fully integrated into the patient's record than InstyMeds is.
Convenience at What Price?
Critics of these on-the-spot systems (which are also being groomed for use in emergency rooms, pharmacies, and drive-by machines) say they eliminate the all-important layer of safekeeping provided by the pharmacist, who can counsel patients on what to watch for, answer questions, and keep track of a patient's total medication load (if all his drugs come from the same pharmacy).
According to Rosenblum, though, InstyMeds is better than the old way, because not only can the patient talk to a pharmacist from a phone provided next to the machine, but the medication load is also monitored by the insurer, who has access to all the patient's copays and records. And doctors need to counsel patients about what they will be taking, anyway, Rosenblum adds.
The Institute of Medicine in Washington says that medication errors kill 7,000 people a year. "You'd be amazed by all the medications that sound alike or look alike," Rosenblum says. "This eliminates all of that potential for error [by printing rather than scrawling prescriptions]."
Others have criticized the systems, saying they penalize the poor who may not have credit cards. But "if the person is on assistance, they may not have a copay, and that part of the sequence does not even come up on the screen," Rosenblum responds. Another advantage with the system, he says, is that more patients will actually get their needed prescriptions. As many as 25% of people who receive a prescription never get it filled, but this number is cut when they can get the medicine on the spot.
The proof may be in the medicating. Of people who have tried the InstyMeds and walked out of their doctor's office ready to start their medication, 94% say they want to use it every time.
"Oh, the patients love it," pediatrician Richardson says. "When one kid is barfing, you don't want to drag them all over to the pharmacy."
Originally published Sept. 16, 2002.
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