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Prescription medication kiosks just what the doctor ordered

Kiosks that dispense prescription meds raise eyebrows and worries about abuse, but industry executives say the systems are safe and ready to roll out.

December 28, 2009 by Christopher Hall — w, t

Kiosks designed to remotely dispense prescription medication are clearing the final hurdles to implementation, and may soon be rolling out in the United States and in Canada's most populous province.

Medication-dispensing kiosks raise concerns about safety and improper access to potentially dangerous substances, but executives in the sector say the machines are safe — and in some ways perhaps better than the traditional pharmacy method of dispensing prescription medications.

California-based eAnytime has medication-dispensing kiosks the company trumpets as "foolproof" that are basically waiting on a better economic climate to roll out en masse, according to eAnytime president and CEO Laurence Cohn.

And the Ontario, Canada-based PCA Services is awaiting only the adoption of needed regulations before moving forward with its medication-dispensing kiosks, says PCA co-founder and CEO Don Waugh.

The Ontario legislature recently passed a bill clearing the way for prescription drug sales from self-service kiosks in the province, and PCA plans to put hundreds of kiosks in malls and grocery stores across Canada's second-largest province by area and its most heavily populated.

"It (the idea of prescription medication kiosks) is gaining popularity, and we have orders that we're going forward with," Cohn said last week.

Many if not most of his clients, though, are entities like Department of Veterans Affairs hospitals and medical and addiction recovery clinics that are consistently underfunded, Cohn said.

And Waugh says PCA Services also has a backlog of orders for its machines once the final regulations are in place.

Technology providers like PCA and eAnytime also have to deal with problems of perception about the safety and wisdom of dispensing medications through a kiosk, but the safety controls in place, as well as the real benefits to consumers, should eventually overcome those concerns, said Don Waugh, co-founder and CEO of PCA Services.

The PCA kiosks, called PharmaTrust machines, have been tested out in a few Ontario hospitals for the last two years. With them, customers put their prescription in and then speak to a remote pharmacist via video conferencing and pay at the kiosk before their medication is released.

PCA machines also will not be used to dispense narcotic medications, which should allay some fears of abuse, Waugh said.

While it lacks a one-on-one consultation component, the eAnytime machine, the MDS 5.0, incorporates several layers of security, including an onsite attendant or nurse who pre-qualifies the patient to receive the medication; barcode and finger scanning; as well as alternate verifiable ID numbers for patients who can't scan their fingers.

And Cohn said his company worked long and hard with the U.S. Drug Enforcement Agency (DEA); pharmaceutical companies; large clinics; and pharmacists' boards to figure out how to safeguard their kiosks against abuse.

"You have to have a very safe system and a very accurate system," Cohn said. "We designed a foolproof system."

Another of the MDS' primary benefits is its speed: most doses can be doled out in about 60 seconds, Cohn said.

And the machines could be of potentially huge benefit to patients who need medications but may not have a pharmacy nearby or to slim-budget medical clinics that can automate and speed up the dispensation process, Waugh and Cohn said.

"The biggest concern seems to be the lack of physical, face-to-face interaction with the pharmacist, but there are many communities that are not served by pharmacies or pharmacists," Waugh said last week.

Remote communities, where it's not economically feasible to have pharmacies, could be served practically by a PharmaTrust machine, Waugh said. In a community of 600 people, it's just not realistic to expect a company to operate a pharmacy when the average pharmacy in Canada serves approximately 5,000, he said.

"If it was economical for pharmacies to be in remote communities, they would be," he said. "The disparities between rural Canada and urban Canada are significant, and you need technology that can service the needs of people who are in remote communities. This is the type of technology that can do it economically."

In addition to providing pharmaceutical services to remote areas, medication kiosks also help solve the "hours-of-operation" dilemma that banks solved years ago with ATMs, by providing potentially 24-hour service,Waugh said.

The PCA kiosks also free up PharmaTrust pharmacists to take time that otherwise would be spent physically finding, counting and dispensing the medications in a bricks-and-mortar pharmacy and spend it counseling patients on their medications and the necessary precautions, he said.

"The greatest benefit that this system has is that it's freeing the pharmacist up from what they call the technical aspects of the job," Waugh said. "Our pharmacists aren't doing that; they're actually having a one-on-one session with the patients and reviewing not just this drug but all drugs they're on and doing more counseling. ... Eighty percent of the (prescription) errors are found in that counseling event."

Automating the physical aspects of dispensing the medications also removes the potential for human error, he said. The error rate in Canada is about 1,000 dispensation errors per 60,000 scrips, he said, "about 60 of which are critically imperative." The PharmaTrust machines have been dispensing with 100 percent accuracy, he said.

Combine better counseling and better accuracy, and you also have a system that could save lives and saves the health care system money, according to Waugh.

Not taking medications as prescribed and/or adverse reactions to medications — or to the wrong medications — make up about 15 percent of Canada's emergency room visits, Waugh said, but "by having more time with the pharmacist. ... I sincerely hope our patients will do better and not show up in the emergency room, because they are managing their medicine properly."

Finally, the people most responsible for deciding the future of prescription medication-dispensing machines — the consumers — appear to be more than ready to be early adopters, Waugh said. PCA's exit surveys show "very positive" responses, and the percentage of respondents who say they'd use the kiosks again is in the 90s, he said, crediting the banking industry for paving the way.

"What's very interesting is that this is across all age groups, even elderly patients," Waugh said. "They use ATMs every day, so why not this?"

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