A Canadian firm says it can help the healthcare industry cut down prescription errors and improve patient-pharmacist contact by installing automated pill dispensing kiosks at doctors’ offices, clinics, drugs stores and hospitals.
PharmaTrust, a sleek green and white box similar to an automated teller machine (ATM), can read doctor’s prescription scripts, dispense 150 commonly prescribed drugs, collect and manage patient records and set up a remote live video conference with a pharmacist.
The machine, developed by PCA Services Inc., of Oakville, Ont., will soon be tested by the Sunnybrook Health Services Centre in its hospital pharmacy in Toronto.
The kiosk is a complex system which incorporates radio frequency identification (RFID) technology, data encryption, Web-based video communication and robotics, but it’s as easy to operate as any run-of-the-mill ATM, according to Don Waugh, co-founder and CEO of PCA Services Inc.
“Basically, patients feed their prescription to the machine, pay via credit card, debit card or cash, and get their bottle of medicine,” said Waugh.
A licensed pharmacist located in PCA’s call centre is also available to provide live counseling via video conferencing hook-up, he said.
“This is not so much about automating drug dispensing as it is about improving patient-pharmacist contact and reducing prescription errors,” Waugh insists.
But the head of Sunnybrook’s pharmacy department said the machine is likely to be met with skepticism by some doctors, pharmacists and patients.
“I think I was a little uncomfortable that it might displace pharmacists,” said Thomas Paton, director of pharmacy at Sunnybrook.
Sunnybrook is scheduled to try out one of the PharmaTrust units inside the hospital’s pharmacy in Toronto.
“If the machine were to be placed at a doctor’s office, a clinic or another location, that would cut out the pharmacist from the process.”
Paton also said he anticipates some doctors and patients would initially hesitate to use the automated dispenser just as some people were reluctant to do banking on the first ATMs.
However, Paton is willing to try out the PharmaTrust. “It’s going to be here whether I like it or not. If it’s going to benefit and support pharmacists as an additional tool, I want to try it out.”
Paton said the machine might relieve long lineups in busy pharmacies, allowing pharmacists to concentrate on medicines that require special preparation or providing patient counseling.
Areas where drug stores close early or remote locations where there are no pharmacies might also benefit from the machine.
Waugh paints a scenario of how a typical PharmaTrust transaction might proceed:
1) A doctor creates an electronic prescription for a patient by entering pertinent information such as illness, identity and drug dosage in the PharmaTrust application and printing out a uniquely bar-coded prescription slip. This document contains the doctor’s encrypted electronic signature.
2) The patient takes the prescription and has the option of submitting it to a live pharmacist or using the PharmaTrust dispenser.
3) To obtain drugs from the dispenser, the patient inserts prescription into the appropriate slot on the machine. The machine reads the prescription and searches for the required medication.
4) A series of robotic mechanisms guided by RFID technology pick out the pills, bottle the right amount and dispense the medication.
5) In the background, the system updates the patient’s file, sends a report to doctor and calls up pharmacist that is standing by at the PCA call centre.
6) The pharmacist provides the patient with required counseling pertinent to the medication via video conferencing. In the case of extended medication, the pharmacist also calls the patient at home to remind him or her to re-order the medicine.
“The dispensers will only contain commonly prescribed medicines and not narcotic products that could be targeted by drug addicts or criminals,” Waugh said.
As a licensed drug wholesaler, PCA Services Inc. will provide the machine to doctors, hospitals, clinics and pharmacies as a turnkey business. The company will earn from service and maintenance fees while businesses renting the machines benefit from a revenue sharing plan.
“There are no legal hurdles that stand in the way of them (PCA Services Inc) moving forward,” Anthony de Fazekas, partner at the Miller Thomson LLP, in Toronto, the firm that was retained by the company to ensure that PharmaTrust complies with federal and provincial health care regulations.
Under Canadian laws, physicians are allowed to dispense and sell drugs. Online privacy laws also allow the transmission of private patient information in digital form.
Waugh said recent industry studies indicate that nearly 25 per cent of emergency patients admitted to hospitals involve drug intake complications such as adverse effects or non-compliance with medication instructions. But about 28 per cent of that number can be traced to prescription error such as misreading labels and doctor’s handwriting.
Many patients also miss out on vital information about the drugs they are taking or fail to comply with medication schedules because of poor counseling and follow-up procedures, Waugh added.
Surveys indicate that pharmacists spend just 17.8 per cent of their time counseling patients. The rest of their time is taken up by administrative duties such a preparing medication and taking care of medical supplies.
“This machine will help free up pharmacists to provide more essential services rather than stacking supplies,” the PCA chief said.
Waugh was previously involved in another venture that proposed the use of data encryption to facilitate Web-based drug prescription. He was, however, unable to identify an ideal business model for his system.
“The doctors were not prepared to pick up the cost and the pharmacists appeared to be satisfied with dealing with the handwritten prescriptions they were getting from physicians.”
PCA developed the custom kiosk software using mainly Microsoft-based applications, according to Peter Suma, co-founder, president and chief operating officer of the PCA.
The system uses Microsoft Server 2008 in the backend and encrypts data at rest and in transmission to secure patient private information. For video conferencing functions, the system relies on Microsoft Office Communication Server and SQL server.
An RFID system tracks the medications in the kiosk to determine expiration dates and supplies and ensure that the right pills are dispensed for the appropriate prescriptions.
The system also produces reports and updates patient records so that doctors can determine if their patients bought the prescribed medicine. Patient records remain the property of the doctor or hospital, Suma said.
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