US20030125837A1 - Systems and methods for drug dispensing - Google Patents
Systems and methods for drug dispensing Download PDFInfo
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- US20030125837A1 US20030125837A1 US10/315,293 US31529302A US2003125837A1 US 20030125837 A1 US20030125837 A1 US 20030125837A1 US 31529302 A US31529302 A US 31529302A US 2003125837 A1 US2003125837 A1 US 2003125837A1
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- G—PHYSICS
- G07—CHECKING-DEVICES
- G07F—COIN-FREED OR LIKE APPARATUS
- G07F5/00—Coin-actuated mechanisms; Interlocks
- G07F5/18—Coin-actuated mechanisms; Interlocks specially adapted for controlling several coin-freed apparatus from one place
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- G—PHYSICS
- G07—CHECKING-DEVICES
- G07F—COIN-FREED OR LIKE APPARATUS
- G07F17/00—Coin-freed apparatus for hiring articles; Coin-freed facilities or services
- G07F17/0092—Coin-freed apparatus for hiring articles; Coin-freed facilities or services for assembling and dispensing of pharmaceutical articles
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- G—PHYSICS
- G07—CHECKING-DEVICES
- G07F—COIN-FREED OR LIKE APPARATUS
- G07F7/00—Mechanisms actuated by objects other than coins to free or to actuate vending, hiring, coin or paper currency dispensing or refunding apparatus
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- G—PHYSICS
- G07—CHECKING-DEVICES
- G07F—COIN-FREED OR LIKE APPARATUS
- G07F9/00—Details other than those peculiar to special kinds or types of apparatus
- G07F9/001—Interfacing with vending machines using mobile or wearable devices
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- G—PHYSICS
- G07—CHECKING-DEVICES
- G07F—COIN-FREED OR LIKE APPARATUS
- G07F9/00—Details other than those peculiar to special kinds or types of apparatus
- G07F9/002—Vending machines being part of a centrally controlled network of vending machines
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
- G16H20/13—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients delivered from dispensers
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
- G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
- G16H40/67—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation
Abstract
The present invention relates to systems and methods for the remote dispensing of packaged and non-packaged medical products using networked communications systems. A preferred embodiment of the invention utilizes a network to provide for the secure delivery of confidential patient information and the sending of dispense instructions to a remote dispensing station. A preferred embodiment of the present invention relates to systems and methods of dispensing samples of drugs or other medical products. Another preferred embodiment of the invention provides a system and method for dispensing non-prescription medications.
Description
- This application is a divisional application of U.S. application Ser. No. 09/454,359 filed on Dec. 3, 1999 which claims the benefit of U.S. Provisional Application No. 60/155,446 filed Sep. 22, 1999, the entire teachings of the application being incorporated herein by reference.
- Automated pharmaceutical delivery systems have been in use for over thirty years. The initial purpose of such systems was to reduce the high rates of medication errors associated with manual distribution. In modem times, automated systems present more sophisticated advantages. These include further reduction of errors, lower costs associated with pharmaceutical distribution, reduction of personnel, inventory control, substance control, automated documentation, and relieving professional pharmacists of many tasks.
- The current state of the art of automated pharmaceutical delivery systems, otherwise known as medication management devices generally fall under three categories: automated devices in the central pharmacy area; automated devices in the patient care unit; and point-of-care information systems.
- The primary goal of centrally-located devices is to replace or improve the current manual process for filling unit dose carts. These devices offer the advantage of a single, centralized inventory and a lower overall inventory. Disadvantages of such devices include their large size, high cost, and reliance on efficient delivery systems.
- Patient care unit-based devices replace the traditional manual unit dose cart filling and delivery system and provide increased control over floor stock. Advantages of such systems include their smaller size and lower cost relative to centrally-located devices, immediate access to medications, and automated documentation of medication administration. Disadvantages include application to unit dose levels only, increased costs due to the maintenance of multiple inventories in multiple units, additional time required to restock multiple devices, and larger inventory. Point-of-care systems are designed to enable immediate exchange of patient data at the bedside. Such systems allow for rapid access to patient information, fast documentation, integration of hospital information systems, and immediate verification of drug administration. Primary disadvantages of point-of-care systems include high cost associated with placing hardware in each room, networking the system, and security issues associated with personal data access.
- The above-described systems offer solutions for medication management in large hospitals where the large expense associated with large centrally-located pharmacy systems, decentralized patient care units, and point-of-care systems at the bedside are justifiable for unit-dose dispensing and verification. These systems fail to address efficient and economical medication management at medium size facilities, for example health maintenance organizations which cannot justify the expenses associated with the large and costly aforementioned systems. Furthermore, while the above systems provide a solution for unit-dose dispensing for individual patients, they fail to address the issue of filling weekly or monthly prescriptions in a cost-effective manner.
- The present invention relates to a method for remote dispensing of pharmaceuticals or other medical products using a distributed, interoperable, packet-switched network such as the Internet and to a system that combines computer hardware and software, including a computer network, a telecommunications capability, and a medical products dispensing cabinet to form a complete drug dispensing system. The medical products may include, but are not limited to, packaged or non-packaged pharmaceuticals or individual pills, caplets, tablets, liquids, or suspensions. This enables drug prescription dispensing in volume by a physician, pharmacist, or other licensed practitioner directly to the patient at a clinic, group practice, or other location outside a pharmacy or a hospital. The system provides a convenient, safe, automated, and low cost drug delivery system for the patient.
- A preferred embodiment of the present invention is directed to an apparatus and method for automated dispensing of packaged and non-packaged pharmaceuticals. The remote control dispenser system of the invention includes a centralized computer network in conjunction with product release at a remote location. The centralized network communicates with the remote distribution point using standard Internet Protocols (IP) or higher level application protocols such as Hypertext Transport Protocol (HTTP). In another preferred embodiment, a web browser can be employed as a tool to provide for the controlled remote dispensing of packaged and non-packaged pharmaceuticals. In another preferred embodiment a customized web server can be employed as a tool to provide for the controlled remote dispensing of packaged and non-packaged pharmaceuticals. The systems and methods of the present invention provide for the efficient remote dispensing of medical products using widely available communications network technology while preserving the confidentiality of patient information and the safety of users based on restricted access to controlled substances.
- A preferred system and method for remote dispensing of a medical product, such as, for example, a prescription pharmaceutical includes an authorization node, a dispensing node to distribute the authorized medical product, a controlling node that interfaces with the authorization node and the dispensing node and a transmission medium between the nodes. The authorization node can include a controller and appropriate software used by a pharmacist or a licensed physician. The dispensing node can include a housing having a plurality of bins which store encoded packages of medical products and a dispenser controller. The controlling node, which may be collocated with the authorization node, includes a customized web server to control the flow of information between the authorization and dispensing node.
- A preferred embodiment of the present invention relates to systems and methods of dispensing samples of drugs or other medical products. Samples are often given to patients by physicians at clinics, offices, or hospitals. These samples are provided free of charge to physicians or institutions for distribution to patients. At present, there are no systematic procedures for controlling the distribution of samples and there are increasing requirements by regulatory and accrediting institutions to provide such controls.
- Samples are usually packaged as unit doses in small foil and/or plastic containers with labels intended to identify a particular brand name or manufacturer so that the patient will then associate the particular medication with a particular source. Thus, the packaging for different samples from different sources tend to be varied in size and shape.
- Thus, a system for containing and monitoring distribution in accordance with the present invention includes a number of trays or drawers in which the samples are stored, a control system that opens and closes the system to provide access to the user and secures the system to restrict unauthorized access.
- A user identification system can be included that serves to identify those gaining access to the dispensing system. This system can include a computer containing a catalog of medications dispensed using the system as well as patient data, or alternatively, accessing such information using a communication network as described herein.
- Another preferred embodiment of the present invention provides a system for dispensing non-prescription medications or other medical products that do not require a licensed physician or pharmacist to be involved in the transaction. Such a system can include a secure storage housing that dispenses individual packages based on credit card, debit card, cash, or other smart card transactions. The system can utilize features of the communications network, code reader, and dispensing systems described herein to provide for the distribution of “over the counter” medical products.
- The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawing are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
- FIG. 1A is a diagram of a preferred embodiment of an automated drug dispensing system in accordance with the present invention.
- FIG. 1B is a perspective illustration of a rack of columns in accordance with the present invention.
- FIG. 1C is a perspective illustration of drawers of helix dispensers.
- FIG. 1D is a perspective illustration of a system including helix and column dispensers in accordance with the present invention.
- FIG. 2 is a flow diagram representing the processes performed by the pharmacy technician at a Remote Control Dispenser (RCD) in a remote-dispense location and a registered pharmacist, R.Ph., at a remote control location in accordance with the present invention.
- FIG. 3 is a schematic block diagram illustrating the drug dispensing system in accordance with the present invention.
- FIG. 4A is a schematic block diagram illustrating a drug dispensing system having a host system in one city and a remote drug dispensing system in different cities in accordance with the present invention.
- FIGS.4B-4C are schematic block diagrams illustrating the transfer of information between the host system and the dispensing system in accordance with the present invention.
- FIGS.5A-5C are schematic block diagrams illustrating the sequence of the transfer of information between a host system and a remote drug dispensing system, using the Internet, in accordance with the present invention.
- FIGS. 6A and 6B are flowcharts illustrating the process to dispense medications in accordance with the present invention.
- FIG. 7 is a schematic block diagram illustrating a drug dispensing system having an integrated touchscreen computer and print module in accordance with the present invention.
- FIGS. 8A and 8B are schematic block diagrams illustrating a remote control dispensing system which uses a server to control drug dispensing in accordance with the present invention.
- FIGS.9A(1) and 9A(2) are a schematic block diagram illustrating a preferred embodiment of the remote control dispensing system which uses an internal data socket network configuration in accordance with the present invention.
- FIGS. 9B and 9C are flow charts illustrating the process to dispense medications using the preferred embodiment of the present invention illustrated in FIGS.9A(1) and 9A(2).
- FIGS.10A(1) and 10A(2) are a schematic block diagram of a preferred embodiment of the remote control dispensing system using the internet and host pharmacy system network configuration.
- FIGS.10B-10D are flow charts illustrating the process to dispense medications using the preferred embodiment of the present invention illustrated in FIGS. 10A(1) and 10A(2).
- FIG. 11A is a schematic block diagram of a preferred embodiment of the remote control dispensing system using the internet network configuration.
- FIGS.11B-11D are flowcharts illustrating the process to dispense medications using the preferred embodiment of the present invention illustrated in FIG. 11A.
- FIGS. 12A and 12B are schematic block diagrams illustrating the use of a telephone network in a drug dispensing system in accordance with the present invention.
- FIG. 13A is a schematic block diagram of a preferred embodiment of the remote control dispensing system using a telephone network direct dial configuration.
- FIGS. 13B and 13C are flow charts illustrating the process to dispense medications using the preferred embodiments of the present invention illustrated in FIG. 13A.
- FIGS. 14A and 14B are schematic block diagrams illustrating the use of a pager service in a drug dispensing system in accordance with the present invention.
- FIGS. 15A and 15B are schematic block diagrams illustrating the use of a satellite system to transfer information in a remote control drug dispensing system in accordance with the present invention.
- FIGS.16A-16E illustrate views of the display screen that a user interfaces with during a dispense process to dispense a drug sample in accordance with a preferred embodiment of the present invention.
- FIGS.17A-17C illustrate views of the display screen that a user interfaces with during a maintenance process including loading medications in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIGS.18A-18D illustrate views of the display screen that a user interfaces with during a maintenance process including an inventory process in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIGS.19A-19C illustrate views of the display screen that a user interfaces with including a prescriber process in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIGS. 20A and 20B illustrate views of the display screen that a user interfaces with during a transaction process in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIG. 21 illustrates views of the display screen that a user interfaces with during a history loading process in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIG. 22 illustrates views of the display screen that a user interfaces with during a report process in accordance with a preferred embodiment of the present invention which includes dispensing of drug samples.
- FIGS. 23A and 23B illustrate views of the drug sample dispenser in accordance with the present invention.
- FIGS. 24A and 24B illustrate views of a computer chassis located within the dispenser illustrated in FIGS. 23A and 23B.
- FIG. 25 illustrates a view of a computer mounted on the chassis located within the dispenser illustrated in FIGS. 23A and 23B.
- FIGS. 26A and 26B illustrate views of a motion control system located within the dispenser illustrated in FIGS. 23A and 23B.
- FIGS.27A-27D illustrate views of an embodiment of a bin located within the dispenser illustrated in FIGS. 23A and 23B.
- FIG. 28 illustrates a view of an introductory display screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 29 illustrates a view of a display screen showing in particular a drug category selection screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 30 illustrates a view of a display screen showing in particular a drug availability screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 31 illustrates a view of a display screen showing in particular a drug list screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 32 illustrates a view of a display screen showing in particular a user identification screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 33 illustrates a view of a display screen showing in particular a ready-to-dispense screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 34 illustrates a view of a display screen showing in particular an ending screen that a user interfaces with to dispense a non-prescription drug in accordance with a preferred embodiment of the present invention.
- FIG. 35 illustrates a detailed view of the preferred embodiment of the non-prescription drug dispenser in accordance with the present invention.
- FIG. 36 illustrates a view of an embodiment of the helix trays of the non-prescription drug dispenser in accordance with the present invention.
- FIG. 37 illustrates a view of the details of an embodiment of a door installed in a preferred embodiment of the non-prescription drug dispenser in accordance with the present invention.
- The present invention relates to systems and methods for the remote dispensing of packaged and non-packaged medical products including the methods for controlling a drug dispensing system described in U.S. patent application Ser. No. 09/058,524 filed Apr. 10, 1998, which is a continuation of PCT/US96/16758, filed Oct. 18, 1996, which is a continuation-in-part of U.S. patent application Ser. No. 08/642,484 filed on May 3, 1996, now U.S. Pat. No. 5,797,515 which issued Aug. 25, 1998, which is a continuation-in-part of U.S. patent application Ser. No. 08/544,623 filed on Oct. 18, 1995, now U.S. Pat. No. 5,713,485 which issued Feb. 3, 1998, the entire contents of the above patents and applications being incorporated herein by reference.
- The present invention provides safe pharmaceutical prescription dispensing directly by physicians, pharmacists, and other trained or licensed practitioners operating in small to medium size locations in a cost-effective manner. The dispensing locations can be remote from the location of a licensed practitioner such as, for example, a pharmacist. Prepackaged pharmaceuticals are stocked at nearby municipal service centers and distributed to the health care locations as needed. The inventory is continually and automatically monitored by a host computer at the location, and/or off-site on a central server. Inventory is ordered on a just-in-time basis by the computer. In this manner, prepackaged multiple-dose pharmaceuticals are available to practitioners at the health-care facility for immediate filling of patient prescriptions.
- The present invention offers significant advantages to physician group practices. The system improves customer service and enhances the image of the group practice. Drug theft is prevented by securing the pharmaceuticals in a closed system on hand and inventory is kept low. The system meets state pharmacy, safety, and regulatory compliance laws, whereas many manual dispensing systems do not. A pharmaceutical distributor can handle all inventory planning, financing, maintenance, and ordering with minimal interaction with group practitioners. Disruptive telephone calls to the physician from pharmacists are minimized. Further, physicians can gain immediate access to a patient's pharmacy records currently unavailable to him.
- Managed care providers, for example, Health Maintenance Organizations and Pharmacy Benefits Managers also realize significant advantages from the present invention. The invention increases the likelihood that a patient will receive the required treatment, because the pharmacy is available at the doctor's office. Labor costs for in-house pharmacies are reduced, allowing staff reductions or reassignments. In-house drug dispensing can be extended to physician-staffed satellite clinics and other locations not suitable economically for conventional pharmacies. The system enables automated patient compliance enhancing programs, drug utilization analysis, and the use of other emerging pharmacy management opportunities to reduce costs and improve patient compliance and wellness. Drug costs are reduced by formulary control, thereby encouraging generic substitution of name brand drugs. Inventory is tracked automatically by the drug distributor headquarters, thus preserving professional time for patient care.
- The present invention also offers significant advantages to the patients. Drugs are provided immediately at the physician's office, avoiding an inconvenient trip to a pharmacy. This is particularly important to mobility-impaired patients and eliminates a major source of drug non-compliance. Electronic third-party payor cards such as smart cards can be used for drug purchases at the doctor's office. The patient can obtain prescription drugs at prices competitive with retail discounters. The physicians are able to track prescription compliance which can result in faster recovery.
- The apparatus of a preferred embodiment of the invention will now be described. FIG. 1A is a diagram of an automated drug dispensing system in accordance with the present invention. The primary components of the system include a remote control dispenser (RCD)
cabinet 20, ahost computer 46, amodem 52, adocument printer 56, and a label printer 54. Thecabinet 20 includes arack 24 comprising a plurality of bins, preferably in the shape ofcolumns 34.Packages 32 such as drug bottles, containing pharmaceuticals of various types are distributed among thecolumns 34, eachcolumn 34 containing a separate type of pharmaceutical, ormultiple columns 34 containing the same pharmaceutical to help prevent stock outs on more frequently dispensed pharmaceuticals. A plurality of racks, for example, fourracks 24 are enclosed in thecabinet 20 chamber, two in themain cabinet 20 and two on thedoors 22. The doors are secured bylocks 28. - A licensed user, for example, a doctor, pharmacist, nurse, or other medical practitioner qualified to fill patient prescriptions, operates the system at the
host computer 46, using akeyboard 50 andmouse 66 for input and receiving visual feedback at amonitor 48. In an alternative preferred embodiment, a touch screen can be used for input. Using thekeyboard 50, a user enters a command to request dispensing of a particular packagedpharmaceutical variety 32 for a particular patient. Thecomputer 46 transmits the request via aninterface 70 to acontroller 42 located on theRCD cabinet 20. Thecontroller 42 interprets the command sent from thecomputer 46 and enables a dispensingactuator 68 in theappropriate column 34. Thelowest package 32 in theappropriate column 34 is released from thecolumn 34 and ejected onto aramp 30. The releasedpackage 74 slides down theramp 30 into anopening 26, where the releasedpackage 74 is made available to the dispensing party for transfer to the patient. Abar code reader 40, located near the dispensingopening 26, reads acode 98 on the dispensedpackage 74 and transmits the bar code information to thecomputer 46, which informs the user whether thecode 98 on the dispensedpackage 74 matches that which was requested by the user. Thebar code 98 can be disposed on the side, top, and/or bottom of thepackage 32. In an alternative embodiment, a semiconductor chip can be embedded in the dispensed package which, when passed through an RF field, charges a capacitor. When the capacitor reaches an appropriate level, a weak RF signal is emitted. The signal can include approximately a 12 digit number. The semiconductor chip can also be used to uniquely identify a dispensed item. - In an automated embodiment of the system,
sensors 36 located on eachcolumn 34 monitor the dispensing process and notify thecontroller 42 of any package jams. Thesensors 36 also monitor inventory of thecolumns 34 and notify thecomputer 46 throughcontroller 42 that a particular column is empty or near empty. - Alternatively, the prescription can be dispensed directly to the patient. A
card reader 38, mounted directly on or near the cabinet, is adapted to receive acard 39 from a patient. The card is programmed with patient information that is stored in an electronic memory on the card by a licensed practitioner. The patient inserts thecard 39 in thecard reader 38 and receives his medication automatically from the cabinet. Themedication bottle 32 may be filled with a single dose of medication for a particular patient, or can include weekly or monthly doses. This embodiment is especially useful in large institutions, such as prisons, where many individuals require medication on a regular basis. - Upon validating the
bar code 98 or the unique electronic signature of the dispensedpackage 74, the computer generates alabel 58 containing prescription information at a label printer 54 to be placed on the package, and generates adocument 60 at adocument printer 56 containing additional instructions for the patient or practitioner. Amodem 52 enables periodic or continuous communication between thehost computer 46 and other computers in the network so that a complete inventory and status of each remote control dispenser cabinet is available at all times. Several remotecontrol dispenser cabinets 20 can be integrated into a single installation operated by asingle computer 46. Thecabinets 20 can each be individually connected to thehost computer 46, or may be daisy-chained, with only onecabinet 20 in the chain connected to thehost 46. - The
RCD controller 42 receives commands from and transmits status information to thehost computer 46 via thecontroller interface 70. A request command sent from thehost computer 46 identifies thepharmaceutical package 32 to be dispensed. In response, theRCD controller 42 activates theappropriate dispenser 68, thereby releasing a single package of the variety requested. A parallel or serial I/O interface 62; at thehost computer 46 provides a sufficient communication channel. The simplest interface is a unidirectional channel from thehost computer 46 to thecontroller 42. A full duplex implementation allows thecontroller 42 to transfer status information back to thehost 46. Status information may include errors such as package jams, empty columns, or other cabinet status. Availability of such information prevents inconsistencies in the database and provides the operator with recovery procedures. This would requireadequate sensors 36 to be mounted in appropriate positions on theRCD cabinet 20. - The
bar code reader 40 or an electronic digital signal reader can be mounted directly on the unit or can comprise a hand-heldunit 41. It verifies proper loading of theRCD cabinet 20 and proper dispensing of eachpharmaceutical package 32. Before acolumn 34 is loaded withpackages 32, the column bar code label 76 is compared with thebar code label 98 of eachpackage 32 inserted into thecolumn 34. Each time apackage 74 is dispensed from thecabinet 20, the packagebar code label 98 is scanned by thebar code reader 40 to verify that the correct pharmaceutical has been dispensed. Thebar code reader 40 is interfaced to thehost computer 46, through astandard keyboard wedge 64. Thewedge 64 makes thebar code reader 40 input via the bar code interface 72 appears to be coming from thekeyboard 50. Such an interface is a simple and reliable interface to the pharmacy software operating on thecomputer 46. Thebar code reader 40 must be highly reliable and provide a high first read rate. Label printing on thepharmaceutical packages 32 must be of high quality to accommodate this. The electronic digital signal reader interfaces with a communications port (comm port), a network interface card (NIC), or is in direct communication with the computer bus. During loading, the bottles are loaded into each column up to a certain height. The highest bottle in the column is positioned adjacent a bar codedcolumn label 75 running along each column. Thus, the number of bottles in each column can be recorded at loading and tracked during use. - The
host computer 46 runs the pharmacy software, provides a user interface, and supports theRCD controller 42,bar code reader 40, printer, electronic digital signal reader, andmodem 52. A standard off-the-shelf personal computer and operating system are sufficient to meet these requirements. As described above, thekeyboard 50 andmouse 66 receive input from the user and themonitor 48 provides visual feedback. Thedocument printer 56prints documentation 60 such as detailed instructions and a label printer 54 prints package labels 58, for example,prescription information 59 for adherence to the dispensedpackage 74. Using a combination label stock form, a single printer can be used to provide both the patient label and patient education material. Theprescription label 58 may also include a printed picture of the pharmaceutical 57 contained on the bottle to provide additional safety. - The
modem 52 provides a communication link between the municipal service center (MSC) 106 and theremote control dispenser 108. Through this link, inventory of eachRCD cabinet 20 is automatically monitored and updated in theMSC 106 computer. The modem link also serves as a medium to issue restock orders, update pharmacy software running on thehost computer 46, and provide remote diagnostics. The modem can be compatible with standard telephone lines and can be capable of transferring data at sufficient rates. - The pharmacy software operating on the
host computer 46 is a standard commercial software package which provides standard administrative and accounting capabilities. The pharmacy software also supports the unique features of the remote control dispenser system. These include: data communication with theRCD controller 42 via parallel or serial I/O interface 62; network interface card (NIC); data communication with thebar code reader 40 viakeyboard wedge 64; data communication with the municipal service center viamodem 52; printing oflabels 58 with the label printer 54 and printing ofdocumentation 60 with thedocument printer 56. - The
cabinet 20 andrack 24 are preferably fabricated from aluminum, stainless steel, or plastic to be fully compatible with a clinical setting. Therack 34 can be modified to provide for a diversity of packages including various box and bottle sizes, unit-of-use packaging, liquids, syringes, and various non-prescription products, for example, medical supplies. - The
computer 46 can comprise a portable terminal, a notebook computer, or a hand-held personal digital assistant. Voice recognition or voice prompted software can be employed using a telephone or wireless local area network. Voice recognition systems can use a generic or a user-customized system and can include voice signatures. The objective is to maximize system flexibility and ease of use for the doctor and staff without compromising safety. The remote control dispenser system can be utilized as a free-standing system, as a local network integrated with physician office computers, or as a centralized network in conjunction with product release at a remote location. - FIG. 1B is a perspective illustration of a
rack 110 ofcolumns 112. Eachcolumn 112 includes acorresponding roller assembly 114, which is individually addressable by the controller to dispense abottle 116 as shown. After dispensing, apusher 118 pushes the dispensed bottle forward into an off-center tilt tray 120 and returns to its original position. Thetilt tray 120 rotates in the direction shown byarrow 123 for removal of the dispensed bottle by the operator. Either a return spring or gravity returns thetilt tray 120 to its closed position. Note that thetilt tray 120 when opened by the operator prevents entry of the operator's hand or other objects into therack area 110 to avoid pilferage. - To load the
columns 112, eachrack 110 of columns slides out in the direction shown byarrow 124. Each rack preferably includes a key lock at the top with a keying mechanism which retains the key until the rack is returned to its position, preventing loss of the key. After the columns are filled, the rack is returned to its normal position and the key is removed. - FIG. 1C is a perspective illustration of an alternative embodiment of the present invention. In this embodiment,
drawers 120 ofhelix dispensers 122 are contained in acabinet 124. The helix dispensers 122, when activated, rotate in a single direction. As thehelix 122 rotates, any pharmaceutical packages disposed on the helix are pushed forward toward the front of thecabinet 124. One full rotation of thehelix 122 will cause the outermost package to be released, causing the package to fall into thebin 126. After the package drops into thebin 126, an operator slides open thebin 126 and removes the package. While the bin is open, a door blocks the opening between the bin 126 and the dispensing area to prevent pilferage. The helix-dispensing unit described above is particularly suitable for packages of various non-standard sizes, for example boxes, bags, and kits. Larger-sized helixes 122 may be used for smaller packages. Thehelixes 122 are each individually driven by a stepper motor located in the rear of each tray. - FIG. 1D is a remote control dispenser embodiment well-suited for use in a doctor's office or in a small clinic. The
top unit 130 includes a column dispenser as shown in FIG. 1B. Thebottom unit 132 includes a helix dispenser as shown in FIG. 1C. This combination of dispensers covers a range of package styles for controlled substances, tool kits, and bandages for a typical clinic. - FIG. 2 is a flow diagram representing the processes performed by the pharmacy technician at an RCD and a registered pharmacist at the RPH workstation in accordance with the present invention. Initially, a patient presents a prescription to a technician at an
RCD unit 270. The technician determines whether the drug is stocked in theRCD unit 271. If the pharmaceutical is not stocked, then the technician decides whether to electronically transfer via facsimile, email, or otherwise, the prescription to anaffiliate 272. If the prescription is transferred to the affiliated pharmacy, 273, the patient may travel to that pharmacy to receive the pharmaceutical. Otherwise, the prescription is returned to thepatient 274 to be filled at another RCD unit or by another pharmacist of the patient's choosing. - If the drug is stocked at the RCD unit, then patient data is retrieved275, the drug is selected 276, the prescription signa is selected 277 and additional scripts may be entered 278. Following this, the identification number of the prescriber is entered 279 and all data is transmitted to the
RPH workstation 280. At the RPH workstation, the pharmacist verifies theprescription 281 and performs adrug utilization review 282. If issues arise during the review, the pharmacist is immediately made aware of the conflict and given an opportunity to review and, if appropriate,override 283 the contra-indications 284. If the pharmacist decides at this point to discontinue the dispensing 285, the process is aborted 294. If the pharmacist decides to continue the dispensing anyway 284 or there were no contra-indications 283 in the first place, then claim adjudication is performed 286. Duringadjudication 286, a patient's insurance information is automatically verified to determine whether the insurer will pay for the prescription, and if so, if any co-payment is required from the patient. If a negative response is received 287, drug dispensing is aborted 291. Otherwise, the drug is dispensed and verified with abar code reader 288. If an improper drug was dispensed, the technician is notified to abort the process as a system failure has occurred 292. Upon system failure electronic notification is performed. Distribution headquarters or a regional dispensing location or agent can be notified by the RCD system if an incorrect dispense is shown. Electronic notification can take the form of a fax, email, file transfer, pager notification, or any other electronic transfer protocol. If verification is positive, a label is printed and affixed to thebottle 290. The technician then must scan an additional bar code that is created at the time of the printing. This bar code is located on the patient label now affixed to the dispensed item. If verification of this last bar code is positive, the prescription is dispensed to the patient by thetechnician 293. - Referring to FIG. 3, the
drug dispensing system 310 of the present invention includes computers attached to a computer network system, for example, theInternet 320. Three of the systems areRCD workstations 322 which control the RCD hardware ordispensers 324. A computer system, represented by the laptop graphic, is the “Controlling Pharmacist”computer 326. Anothercomputer 328 is a server running typical website type software. - The operating system of the
workstations 322 is preferably a Windows basedsystem, for example, Windows NT systems with access to the Internet via a modem or via a connection to a Local Area Network (LAN), which has access to the Internet. Eachworkstation 322 uses a browser (for example, Microsoft® Internet Explorer) to interact with theserver 328. The interaction entails getting patient information entered, drug information, etc. Instead of a local executable, the Internet and a browser are used. Theserver 328 sends permission to eachworkstation 322 via the browser. The permission protocol is discussed in further detail hereinafter. - In a particular embodiment, the
server 328 runs Microsoft® NT, Microsoft® Internet Information Server (IIS) 4.0, ColdFusion™ and is connected to theInternet 320 via a static Internet Protocol (IP) address. A static or dynamic IP or a unique domain name can be used. - The
server 328 contains and maintains all the information necessary to dispense a drug. It effectively functions as a “mainframe.” - Once the dispense is appropriate that is there are no drug issues, and the patient can pay for the medication, the
server 328 passes to the client browser the necessary codes to cause theRCD 324 to dispense the drug requested. - The
pharmacy controller 326 is shown as a laptop to indicate pictorially that there is no attached hardware RCD's, etc. This system also requires access to theInternet 320 via a modem or LAN, and uses a browser to interact with theserver 328 and theworkstations 322. - The drug dispensing method of the present invention is predicated on the fact that most everybody has access to the
Internet 320. When one logs onto theInternet 320 one gets an IP address, which uniquely identifies a user. Access to the Internet can be through an existing connection LAN, or using a Microsoft® utility for example, dial-up networking. Theworkstation 322 using a bookmark, or Internet Explorer Favorites, or entering the domain name or IP address, connects to theserver 328. Theserver 328, for example, WebDirectRx.com has a password gate to control access and to establish which databases theworkstation 322 has access to. This reduces any confusion regarding the inventory and dispense queues of networks, for example, in Utah, and Florida. Theworkstation 322 gets access from its user ID and password, plus a cookie that uniquely identifies the installation, to the correct databases. Examples are the inventory database, patient database, transaction database, and the dispense queue database. - The
workstation 322 types into WebDirectRx.com the demographics of a new patient, or selects an existing patient. Another preferred embodiment has a host pharmacy or hospital network share access to patient records within its own nodes, or dispense sites. Theworkstation 322 selects and enters the Rx information. Rx Information is the data needed to process a drug Rx. It includes at least an account number, Rx#, Rx date, patient name, prescriber name, SIG, dosage, and insurance information. This information is placed into a queue database that is accessible for read only by theworkstation 322. The Rx information is then available to a pharmacy controller account, who has READ/WRITE access to the queue. Thepharmacy controller 326 uses a browser, and has gone through a password gate. The queue available to thepharmacy controller 326 is based upon the user ID entered to keep the different dispensing networks from sharing or intercepting data not pertinent unto itself. - The
pharmacy controller 326 reviews the Rx information in the queue, processes the information through a Drug Utilization Review (DUR) Process, and performs adjudication as needed. Once these services are completed thepharmacy controller 326 places into a dispense queue the Rx information for the sendingworkstation 322. The sendingworkstation 322 in turn, sees it has an item in its queue, and dispenses that item using one of the methods to dispense a drug from hardware using the network as will be discussed later. - In a particular embodiment, the actual signal sent to the
RCD 324 is triggered by thepharmacy controller 326, assuming the RCD is in a ready state to receive such a signal. Some states require the signal to be controlled by thepharmacy controller 326, versus the caregiver in front of the dispenser. The pharmacy controller can control quite a large network ofworkstations 322. - FIGS.4A-4C schematically illustrate a host pharmacy system in
city 1 connected to aremote dispensing system 340 incity 2 andcity 3. The dispensingsystems 340 are connected to ahost interface controller 342 which acts as a gateway and passes control to thehost pharmacy workstation 344. The information required to process a medication prescription for example, patient information, patient allergies, disease, and medication profile, is sent by the dispense interface central processing unit (CPU) 340 to thehost interface CPU 342. The information is processed by thehost pharmacy server 346 then is sent to apharmacy label printer 348 which in turn prints out a pharmacy label for the requested medication. The pharmacist at thehost pharmacy workstation 344 is sent the physician's prescription or a copy thereof. The physician's prescription can be in a variety of forms for example, a physician's called in instructions, an electronic version, a scanned in version from a scanner co-located with the remotedispensing RCD system 324. The pharmacist interprets the physician's prescription instructions against the label printed out by theprinter 348. If acceptable, the pharmacist redirects the label to thehost interface CPU 342 which now effectively acts as a network printer. Thehost interface CPU 342 parses the output based on a set of instructions and extracts out the prescription information, for example, the patient's name, the name of the drug, SIGNA etc. Thehost interface CPU 342 then sends a signal, or dispense information, to the dispenseinterface CPU 340 in eithercity 2 orcity 3 via theInternet 320. Upon receiving the signal, the dispenseinterface CPU 340 dispenses the appropriate medication from theRCD 324. In the alternative, the dispense interface reconstructs the information and presents it for dispensing from theRCD 324 by the co-located caregiver. As described previously with the dispenseinterface CPU 340 with respect to FIG. 2, the dispensed drug's bar code is scanned along with the printed label and provided to an end user. - FIGS.5A-5C schematically illustrate the sequence followed to transfer information between a host pharmacy system in one city and remote dispensing systems in a different city. As illustrated in FIG. 5A, a connection is first established between the host pharmacy system and a remote dispensing system using a
remote access engine 350. Each location publishes the dynamically assigned IP address to anInternet website 352. - As illustrated in FIG. 5B, the dispense system in
city 3 queries theInternet website 352 for the dynamically assigned IP address of the host pharmacy system. The dispense system then beginsremote control 354 of the host pharmacy system to create a medication prescription. - As illustrated in FIG. 5C, the host pharmacy system queries the
Internet website 352 for the dynamically assigned IP address of the dispense system using adata socket 356. The host pharmacy system then sends the medication prescription release information to the dispense system using the IP address given by theInternet website 352. - FIGS. 6A and 6B are flow charts illustrating the process to dispense medications using a remote controlled dispense system. The prescriber, for example, a physician creates a prescription on paper or via electronic means per
step 360. The prescription is then given to the patient or electronically delivered to a technician who is co-located at a dispenseinterface CPU 340 perstep 362. If the prescription was given to a patient, the patient carries the Rx to a dispenseinterface CPU 340 location perstep 364. The prescription is presented to the technician instep 366. The technician then faxes, or forwards the electronically generated prescription to a host pharmacy location perstep 368. The technician uses theInternet 320 to connect to thehost interface CPU 342 perstep 370. - The
host interface CPU 342 also connects to theInternet 320 perstep 372. The technician enters patient demographics and prescription information in a host pharmacy software over a link perstep 374. A drug utilization review (DUR) process is then conducted by the pharmacist perstep 376. This is followed by an adjudication process perstep 378 if required. A prescription (Rx) label is printed in the host pharmacy software on thepharmacy label printer 348 perstep 380. The host pharmacy then interprets the faxed or electronically generated prescription with the output from the pharmacy label printer perstep 382. The host pharmacy then sends the prescription information to thehost interface CPU 342 perstep 384. Thehost interface CPU 342 sends the prescription information to the dispenseinterface CPU 340 via theInternet 320 perstep 386. The prescription is then placed into a queue for the technician who is co-located with the dispenseinterface CPU 340 perstep 388. The technician then selects the prescription to be dispensed perstep 390. The technician enters their unique user ID per step 392. Upon being queried for a password, perstep 394, the technician enters a valid password. If the password is accepted the item is dispensed from theRCD 324 perstep 396. The item's bar code is read to check if the correct item has been dispensed perstep 398. If the bar code is accurate, as decided perstep 400, a label containing the monograph and patient material is printed perstep 402. The patient label bar code is then read for accuracy perstep 404. A counsel request is made to the patient perstep 406. If a counsel is required perstep 408, then a telepharmacy connection is made between the dispenselocation 340 and the host pharmacy location perstep 410. Once the patient is counseled perstep 412 the dispensing procedure is completed. If however, it is decided instep 408 that a counsel is not required then the procedure for dispensing the medication is completed then. - FIG. 7 illustrates a particular embodiment of a
remote control dispenser 324 having anintegrated touch screen 420 and aprint module 422. This embodiment does away with the need for a workstation co-located with anRCD 324. - FIGS. 8A and 8B illustrate a particular embodiment of the remote control dispense system which relies on a web server such as an
Internet server 430 as illustrated in FIG. 8A, or a customizedweb server 432 as illustrated in FIG. 8B. Abrowser 434 is used to control the dispensing of the medication or package from theRCD 324. TheInternet server 430 and theweb server 432 effectively function as thehost interface CPU 342. - The drug dispensing method in accordance with the present invention includes at least one of the following different methods to dispense a drug from hardware such as the
RCD 324 using a computer network such as the Internet. A first method includes having the web browser which causes a local executable to launch which communicates with the communications port (COMM PORT) of aworkstation 340 and thereby the electronics in theRCD 324. This activates automatically in an unattended fashion, effectively like a batch file running. - A second method to dispense a drug from the
RCD 324 using the Internet includes direct communications between the browser and the COMM PORT. An ADD-ON element is built for the browser that is downloaded each time a dispense signal is to occur, or only once (the first time) and it is called when needed. - A third method to dispense a drug from the
RCD 324 hardware using the Internet is via a customized software application such as, for example, a JAVA APPLET downloaded as part of the permission to dispense. The applet activates the COMM PORT and causes the dispense cycle. - Another method to dispense a drug is to have a local executable which is “WebEnabled” by having built into it a hypertext transfer protocol (http) or file transfer protocol (ftp) service which frequently scans a table on the
server 328 for the needed codes to dispense an item. - Another method to dispense a drug includes pcAnywhere. Both systems are connected to the Internet, one runs pcAnywhere HOST, the other pcAnywhere REMOTE. The remote, via the
Internet 320, controls a local executable—the dispense software—just by entering the host IP address, or searches a sub-net for any connected system running HOST. The dispense protocol remains the same as described herein before. - It should be noted that the software the technician interacts with can exist on an attached and co-located external computer configuration, or as an integrated computer using TouchScreen components built directly into the RCD.
- Referring to FIGS.9A(1) and 9A(2), in this embodiment of the dispensing system an existing host
pharmacy software system 470 with a co-locatedinterface application server 476, and a remotely installed dispense location interact to provide pharmaceutical dispensing across a wide geographic region. This preferred embodiment uses theInternet 482 to communicate Rx dispense information. The hostpharmacy software system 470, via theinterface application server 476, sends Rx dispense information onto the dispenselocation workstation 486. At the dispenselocation workstation 486 the local user, for example, a technician, is presented with a queue of processed prescriptions received from the hostpharmacy software system 470. - The dispense
location workstation 486 contains local executable program(s) that manage the connection to theinternet 482, internet data socket communications, data acceptance, inventory management, and visually prepares the Rx information received from theinterface application server 476 in an easy to read queue for the local caregiver, typically a technician. In addition the dispenselocation workstation 486 communicates with the co-located Remote Control Dispenser (RCD) 490 to dispense packaged pharmaceuticals, aprinter 472, such as a laser jet or color jet printer to provide patient and record keeping materials, as well as, a bar code scanner for doing quality checks during a dispense. The dispense location needs access to a telephone system to get a “dial tone”, or a LAN based Internet connection, in order to receive and send communications. - The
host pharmacy software 470 is maintained or run at the pharmacy control location. Typically these are small networks of pharmacy workstations where a retail or hospital pharmacy team interacts with insurers computers to create the order that leads to the filling of a drug to be handed to the patient. - The
interface application server 476 is a computer that is co-located with the hostpharmacy software system 470. It is used to collect information (the Rx data) for a dispense from the host pharmacy system and then forwards that information to the dispenselocation workstation 486 via theInternet 482. - Referring to FIGS. 9B and 9C, a typical workflow of the embodiment illustrated in FIGS.9A(1) and 9A(2) include the following sequence of steps. An Rx is generated by a Physician or caregiver using a paperless method such as a PDA or TouchScreen or by usual methods using pen and paper, fax and scanners in
step 504. The Rx information typically contains the patient name, prescriber name and Drug Enforcement Agency identifiers, instructions for the administration of the drug, drug name, and quantity to be given to the patient. The Rx is transmitted to different locations perstep 506, for example, if the Rx is transmitted to a pharmacy control location via fax or an electronic means, the authorized dispenser, typically a pharmacist, interprets the transmitted information. Alternatively, if the Rx is transmitted to a dispense location electronically or physically delivered, a user, typically a technician can take authorized action. - Once entered into the host pharmacy system per
step 516, the Rx is manipulated into the host pharmacy software system perstep 518 either by an authorized dispenser interpreting the Rx information transmitted directly to his/her location and then manually or through an electronic interface transfers the Rx information into the host pharmacy software, or the technician has an option to transmit the information to the authorized dispenser, pharmacist, for the pharmacist to manipulate as described hereinbefore or to remotely connect to the host pharmacy software via a variety of interfaces to transfer the Rx information into the host pharmacy software system either manually or via an electronic interface. The connection interfaces can be, but are not limited to, Symantec pcAnywhere directly, Symantec pcAnywhere via the Internet, or by a co-located WAN connection provided with the host pharmacy software. - Once the information is transcribed or transferred into the host pharmacy software system a number of typical processes are applied to the Rx information. The processes can be a Drug Utilization Review which entails scanning the drug to be dispensed against the patient profile contained within the host pharmacy software system to determine if any pharmaceutical contra-indications for dispensing exist. An example of a DUR can be a drug-to-drug interaction test, or a patient drug allergy test. A second typical process is an Adjudication process whereby the host pharmacy Software system communicates with a pharmacy benefit management computer to determine the patient's insurance coverage and payment amounts, if any.
- The Rx information, having been processed by the host pharmacy software system can generally then be determined to be a valid Rx which can be processed by the pharmacist. In a retail setting, the pharmacist then triggers patient drug labeling to be produced by the host pharmacy software system and takes a large bottle of medications from the shelf and counts and places into a smaller bottle, typically called a vial, the number of tablets, caplets, or milliliter's called for by the physician. The pharmacist then applies labeling and hands the drug to the patient. When the dispense is processed in conjunction with the remote dispensing system, the pharmacist or authorized dispenser triggers a patient drug label to be produced by the host pharmacy software system, however, instead of the label being processed by a co-located printer (laser jet or dot matrix) the output is directed to the interface application server. The interface application server accepts the Rx information as a printer stream per
step 520, or through a direct electronic interface to the host pharmacy software system network constructs. - Per
step 522, an application, such as, for example, Parse Engine, parses the output received by the host pharmacy software system into discreet data elements. Once the parsing is completed, the data is then encrypted and is uniquely identified for transmission to the dispense location workstation via the Internet. - The information is received by the dispense location workstation, decrypted and is placed into a work in process queue that is accessed by local executable programs run by the technician per
step 508. - The technician at the dispense location selects the Rx-Drug-Patient to be dispensed from a list of one or more possible to be displayed per
step 510. The selections are shown as mouse selectable lines. Each line represents a different RX-Drug-Patient to be processed by the technician. - Upon selecting the Rx-Drug-Patient to dispense the technician at the dispense location is queried if this is in fact the RX-Drug-Patient per
step 524. If the answer to the query is no, the technician is returned to the entire queue list as described above perstep 512. If the answer to the query is in the affirmative, the local executable program resident on the dispense location workstation examines a local inventory file that contains data specific to the drug requested to be dispensed perstep 526. The drug contains a profile which includes but is not limited to current stock level, suggested restock levels, and coordinate position within a single or plurality of RCD's. - The RCD receives a technician coordinate type communication from the locally resident executable. The X,Y coordinate represents a location within a single or plurality of RCD's where the requested pharmaceutical is stored for dispensing. The X,Y coordinate is determined by examining an inventory profile of the drug to be dispensed. Upon receiving the dispense signal from the dispense location workstation the RCD presents a drug to the technician per
step 528. - As a result of the dispense occurring, the technician is presented with an additional screen which requires the input of bar code data embedded onto the label of the dispensed drug. A bar code reader co-located at the Dispense Location is used to read the bar code of the item dispensed from the RCD per
step 530. The technician reads the bar code into the screen to be examined by the resident dispensing software. - The bar code of the item dispensed is read into the resident dispensing software and is compared with the value of the bar code expected from the drug inventory profile. If the values match per
step 532 what the resident dispensing software is expecting, a patient education monograph, patient labeling, graphic representation of the drug expected, and picture of drug expected are generated perstep 536 and delivered to the co-located printer. If the values do not match what the resident dispensing software is expecting, the user has three attempts with which to scan or enter the expected values perstep 534. If three failed attempts are made, the transaction is terminated with warnings sent to appropriate parties like the authorized dispenser, technician, system operator, and pharmacy consultant via pager and email. Appropriate drug disposal and storage is maintained via training of the technician and an additional lock storage box within the RCD. - The technician at the dispense location is presented with one additional bar code on the patient label that is to be affixed to the item dispensed. The technician is required to perform one more bar code read by scanning the patient label after it is affixed to the item dispensed per
step 538. The bar code of the item dispensed is read into the resident dispensing software and is compared with the a value of the bar code expected, the Rx number. If the values do not match what is expected, then the user has three attempts to scan the correct label before an error condition is reported perstep 542. If the values do match perstep 540, then the dispense is complete and the local technician is returned to the view of the queue show work in process, if any. - If the patient, who has been remotely administered medications has any questions an authorized pharmacist is available for consultation using a variety of telepharmacy systems, including, but not limited to, a telephone system audio
visual connection 488, a networked audio visual connection, and an internet connected audio visual connection. - Referring to FIGS.10A(1) and 10A(2), in another preferred embodiment of the present invention an existing host
pharmacy software system 560 with a co-locatedinterface application server 566, and a designedweb server 574 work in conjunction to provide a third location, the dispense location, with prescription information enough to identify and then dispense a pharmaceutical. - The dispense location uses a web browser, such as, for example, Microsoft® Internet Explorer 5.0, instead of a locally installed executable. The web browser then interacts with data on a
Web Server 574. Theweb server 574 gets its data from theinterface application server 566 which is co-located with a customersPharmacy software system 560. - The dispense location is where the
RCD cabinet 582 is located, along with apersonal computer 580, aprinter 562 such as a laser jet printer, and a bar code scanner. This site has connectivity through a network or telephone system to theinternet 576. - The pharmacy control location is where the host pharmacy software is maintained or run. Typically these are small networks of pharmacy workstations where a retail or hospital pharmacy team interacts with insurers computers to create the order that leads to the filling of a drug to be handed to the patient. The wholesalers have discovered a method to keep distribution by supplying retail outlets with pharmacy software that automatically places reorders with the wholesalers computers based upon use and an inventory threshold stockout level. An example of pharmacy software that can be used, but is not limited to, with the present invention is McKesson HBOC Pharmaserve software.
- The
interface application server 566 is a computer that is co-located with thepharmacy software system 560. It is used to collect information such as, for example, the Rx data for a dispense from the host pharmacy system and then forwards that information to theweb server 574 in accordance with the present invention. Theweb server 574, runs ColdFusion™ with a Structured Query Language (SQL) 6.5+database. The web server stores data sent to it, and displays that data in an easy to understand point and click format. Theweb server 574 is connected to theInternet 576 at a static IP address using a Universal Resource Locator (URL) such as, for example, StarNetLite.COM. Theweb server 574 handles secure transmission of the data as well as the segmentation of data based upon a user login id/profile. - Referring to FIGS.10B-10D, a typical workflow, illustrated as a flow chart, includes the following sequence of steps. Per
step 604, an Rx is generated by a physician or caregiver using a paperless method such as a personal data assistant (PDA), such as, for example, a palm pilot, or TouchScreen or by usual methods using pen and paper, fax and scanners. The Rx information typically contains the patient name, prescriber name and Drug Enforcement Agency identifiers, instructions for the administration of the drug, drug name, and quantity to be given to the patient. Perstep 606, the Rx can be transmitted to different locations. For example, if the Rx is transmitted to theweb server 574 directly, then the image or Rx data is stored to an appropriate table on the web server for retrieval by a user authorized to dispense medications, typically a pharmacist. In the alternative, if the Rx is transmitted to a pharmacy control location via fax or other electronic means, the authorized dispenser, typically a pharmacist, interprets the transmitted information. If the Rx is transmitted to a dispense location electronically or is physically delivered, a user, typically a technician can take the authorized action upon the Rx. - Once the Rx is entered into the host pharmacy system per
step 610, the Rx is manipulated into the host pharmacy software perstep 612 using different methods. For example, an authorized dispenser reviews theweb server 574 captured Rx information in a 10 browser, and then, transfers that Rx information manually or through an electronic interface into the host pharmacy software. Alternatively, an authorized dispenser interprets the Rx information transmitted directly to his/her location and then manually or through an electronic interface transfers the Rx information into the host pharmacy software. The technician has an option, to either transmit the information to the authorized dispenser, pharmacist, for the pharmacist to manipulate as described hereinbefore, or to remotely connect to the host pharmacy software via a variety of interfaces to transfer the Rx information into the host pharmacy software system either manually or via an electronic interface. The connection interfaces can be, but are not limited to, Symantec pcAnwhere directly, Symantec pcAnywhere via the Internet, and by a co-located wide area network (WAN) connection provided with the host pharmacy software. - Once the information is transcribed or transferred into the host pharmacy software system, a number of typical processes are applied to the Rx information. The processes can be, for example, a Drug Utilization Review (DUR) which entails scanning the drug to be dispensed against the patient profile contained within the host pharmacy software system to determine if any pharmaceutical contra-indications for dispensing exist. An example of a DUR can be a drug-to-drug Interaction test, or a patient drug allergy test. A second typical process is an Adjudication process whereby the host pharmacy Software system communicates with a pharmacy benefit management computer to determine the patients insurance coverage and payment amounts, if any.
- The Rx information, having been processed by the host pharmacy software system can generally then be determined to be a valid Rx; which can be processed by the pharmacist. In a retail setting, the pharmacist then triggers patient drug labeling to be produced by the host pharmacy software system and takes a large bottle of medications from the shelf and counts and places into a smaller bottle, typically called a vial, the number of tablets, caplets, or milliliter's called for by the physician. The pharmacist then applies labeling and hands the drug to the patient. When the dispense is processed in conjunction with the web server, the pharmacist or authorized dispenser triggers a patient drug label to be produced by the host pharmacy software system, however, instead of the label being processed by a co-located printer (for example, a laser jet or dot matrix printer) the output is directed to the interface application server.
- The interface application server accepts the Rx information as a printer stream per
step 614, or through a direct electronic interface to the host pharmacy software system network constructs. An application, such as, for example, Parse Engine, parses the output received by the host pharmacy software system into discreet data elements perstep 616. The parse engine, having completed parsing the data, then encrypts the data and uniquely identifies the data for transmission to theweb server 574 via a network or dial-up Internet connection perstep 616. - The information is received by the web server and placed into a work in process dispense queue/SQL database with flags identifying the dispense information as “belonging” to a particular dispense location per
step 624. This is a method designed to permit many simultaneous dispense locations to use the same SQL database. - The dispense locations then have access to the data in the work in process table presented as an HTML document (web page). Only data designated as belonging to a dispense location is available to a dispense location.
- The technician at the dispense location selects the Rx-Drug-Patient to be dispensed from a list of one or more possibilities to be displayed per
steps - Upon selecting the Rx-Drug-Patient to dispense, the technician at the dispense location is shown a dispense detail Page. The dispense detail page presents to the technician additional information about the Rx, not practically visible above. The technician has a choice of deleting the Rx-Drug-Patient selection, or the “GO BACK” to earlier step and select another, or to dispense the drug from the co-located Remote Control Dispenser (RCD)582. The Rx-Drug-Patient selection delete causes an early termination event which is communicated to the pharmacist via an email as an option, and is captured to the correct early termination database for review later or in real-time by the pharmacist or authorized dispenser. The “GO BACK” step prompts the technician to return to the previous list of available dispenses in the work in process table represented by displaying them as a queue on a web page. The selection to dispense the drug from the co-located RCD continues the process by requesting final dispense authority from the web server.
- Final dispense authority is received from the web server in the form of a single web page, HTML document, that expires quickly so that repeat requests for the same drug cannot be made by reversing the browser using its imbedded back button. The
web server 574 completes one more check to determine if the drug requested is still in the local RCD inventory and the location of the drug within the RCD perstep 632. Each RCD contains an Identifier, for example, from 0 to 9 (10 total) and from 00-27, or 00-59 columns, depending upon the configuration. As part of the final dispense authorization the web server returns the exact position of the drug desired within a single or plurality of RCD's. The user clicks a button or link and a series of different options can occur. For example, a JAVA APPLET communicates with the RCD passing the RCD the data culled from the web server. In the alternative, a browser ADD-IN communicates with the RCD passing the RCD the data culled from the web server. In another embodiment, a local one-time use executable is downloaded that communicates with the RCD passing the RCD data culled from the web server. Alternatively, a local executable is launched which passes the needed variables and communicates with theRCD 582 passing the RCD data culled from theweb server 574. In yet another embodiment, an alpha numeric page is sent to an integrated pager reception unit placed within the RCD, which passes the needed variables and communicates with the RCD passing the RCD data culled from the web server. - As a result of the dispense occurring, the technician is presented with an additional web page which requires the input of bar code data embedded onto the label of the dispensed drug. A bar code reader co-located at the dispense location is used to read the bar code of the item dispensed from the RCD per
step 652. The technician reads the bar code into the browser and clicks a test hyperlink, or in some instances the bar code reader can interact with the browser directly and select the test hyperlink directly. - The bar code of the item dispensed is read into the browser and is compared with the value of the bar code expected. If the values match what the
web server 574 is expecting, a patient education monograph, patient labeling, graphic representation of the drug expected, and picture of drug expected are generated and delivered to the technician's browser for subsequent printing to a co-located printer perstep 658. However, if the values do not match what the web server is expecting, the user has three attempts with which to scan or enter the expected values perstep 674. If three failed attempts are made, the transaction is terminated with warnings sent to appropriate parties like the authorized dispenser, technician, system operator, and pharmacy consultant via pager and email. Appropriate drug disposal and storage is maintained via training of the technician and an additional lock storage box within the RCD. - The technician at the dispense location is presented with one additional bar code on the patient label that is to be affixed to the item dispenses. The technician is required to perform one more bar code read by scanning the patient label after it is affixed to the item dispensed per
step 664. The bar code of the item dispensed is read into the browser and is compared with the a value of the bar code expected, the Rx number. If the values do not match what is expected, then the user has three attempts to scan the correct label before an error condition is reported perstep 672. If the values do match perstep 668, then the dispense is complete and the local technician is returned to the view of the queue show work in process, if any. - Referring to FIG. 11A, in this embodiment of a dispense system the majority of the features and functions use a
web server 706 on theInternet 708. Thus, no longer does a local EXE (executable program) reside on the computer at the dispense location (where theRCD 714 is co-located to dispense drugs). Instead the dispenselocation CPU 710 uses anInternet browser 712 to interact with theweb server 706 to access patient information, drug selection, inventory control, and dispense permission. - Referring to FIGS.11B-11D, a flow chart of a typical workflow of the referred embodiment shown in FIG. 11A includes the following sequence of steps. An Rx is generated by a physician using a paperless method such as a personal data assistant (PDA), or by usual methods using pen and paper per
step 724. - The Rx is transmitted to a pharmacy control location per
step 726 whether by an electronic means for a PDA device, or fax for pen and paper method. - The pharmacy control location's pharmacists (Rph) or designated pharmacy technician, is logged onto the Internet, or logs onto the Internet using a local Internet Service Provider (ISP) per step728. This device can be a PDA, a laptop, a cell phone with browser ability, or even a typical personal computer. Any device that is compatible with, but not limited to, HTML or XHTML or similar emerging protocol, can be used.
- Using a device, for example, a laptop computer, the RPh or technician enters a URL (web address) such as, for example, WebDirectRx.com or gets this URL from her favorites List on the browser per
step 730. - The RPh then enters her user id and password per
step 732. This user name and password carries with it a profile. This profile then permits different functionality on theweb server 706 available to the person logging in. A RPh gets a functionality not available to others like Rx generation, and the ability to see multiple dispensing queues across the network of dispensers. - If the patient is new, the RPh needs to enter patient demographics, insurance information, allergies, disease states, drug profile, et al., before beginning to generate an Rx per
step 734. - The RPh then generates the Rx per
step 736 by selecting the patient, drug, prescriber, SIG, tity, refills, ICD-9 (a disease code if known), etc. - The generated Rx is then run through a process called DUR (Drug Utilization Review) per
step 746 to examine the drug for contra-indications against the patient profile. For example, allergies, and drug to drug interactions are examined here. In this embodiment, the process is executed on theserver 706. The RPH or technician then approves the results of the DUR perstep 748 or cancels the Rx or picks a more appropriate therapy. - The RPH or technician then runs an Adjudication on the patient to determine if the patient is insured through a pharmacy benefit management company per
step 752. This process returns a status of, for example, PAID perstep 754, REJECTED, etc. A copay amount, among other items, is returned with a PAID claim. - The Rx is then placed into a queue per
step 758 which the dispense location can see using its own browser. The dispense location caregiver, for example, a nurse, doctor, technician, also needs to be logged onto the Internet. This user/caregiver logs onto the web server at, for example, WebDirectRx.com with a user id and password perstep 760. This user id and password carries with it a user profile perstep 764. The user profile indicates that this person is a dispenser, and can only view the queue for his/her location perstep 766. The user/caregiver sees his/her Rx—the one communicated to the RPh earlier and can now act upon that Rx as it has been approved perstep 768. - The user/caregiver then clicks on the item to be dispensed. This triggers the web server to double check inventory per
step 770 and acquire the location of the drug in the co-located RCD. When completed, the web server returns a page that the user can click on again to cause the computer to send a dispense signal to an RCD perstep 776. The signals, as described hereinbefore, can be sent using different options, such as, but not limited to, JAVA APPLET, browser add-ins, and launching local executables. - The RCD then dispenses the item. Whilst doing that, the
web server 706 presents to the user a screen whereby the user can bar code scan the dispensed item's bar code perstep 780. Upon entry of the bar code a test perstep 790 is made to see if the item is a repackaged item or a manufacturer's packaged item perstep 786. If it is a manufacturer's packaged item, then the web browser presents the user with places to enter a lot number and expiration date perstep 794. The repackaged item has built into the bar code a lot number and expiry date. - If the bar code of the item entered is what the web server, for example, WebDirectRx.com is expecting, then the web server presents the user/caregiver with a completed patient label, patient education monograph, receipts, and image of pill, tablet, capsule etc., that is then to be directed to a co-located laser jet printer per
step 796. Once printed perstep 798, the patient label, which contains a second bar code, is also scanned into a page presented to the user perstep 800. The transaction details are written to a database on the web server, and the user/caregiver is returned to the queue view from where this process started initially. - If the patient, who has been remotely administered medications has any questions, an authorized pharmacist is available for consultation using a variety of telepharmacy systems including, but not limited to, a telephone service audio visual connection, a networked audio visual connection, and an Internet connected audio visual connection.
- FIGS. 12A and 12B illustrate the use of a
telephone network 440 in the drug dispensing system in accordance with the present invention. Thetelephone network 440 transfers information between thehost interface CPU 342 and theRCD 324. Awireless phone 442 can be integrated with the RCD. Thetelephone network 440 takes the place of or is used in conjunction with the Internet as a mechanism to transfer information between the host pharmacy system represented by thehost interface CPU 342 and thehost pharmacy workstation 344 and the remote dispensing system represented by the RCD. The wireless phone device acts as the trigger mechanism to dispense pharmaceuticals or medical products out of the RCD. The wireless phone device can communicate with an integrated circuit within the RCD transferring the RCD information obtained during a wireless connection. - It should be noted that previous preferred embodiments are disclosed with respect to using a communications cable or link between a controlling CPU and the RCD to transfer a dispense message. The communications cable can be replaced with a wireless phone device thus, facilitating dispensing via a wireless connection.
- FIG. 12B illustrates a dispense
interface CPU 340 and alaser printer 444 co-located with theRCD 324. The remotely controlled dispense session can be managed entirely without land lines. The wireless phone connection can be integrated into the RCD or in the alternative, as an attachment to, the dispense CPU. The wireless phone connection serves as the connectivity media instead of the internet connection. - Further, as described hereinbefore, the software the technician interacts with can exist on an attached and co-located external computer configuration, or as an integrated computer using TouchScreen components built directly into the RCD.
- Referring to FIG. 13A, in this embodiment of a dispensing system an existing host
pharmacy software system 850 with a co-locatedinterface application server 856, and a remotely installed dispense location interact to provide pharmaceutical dispensing across a wide geographic region. This preferred embodiment uses the existing local telephone service available. Theinterface application server 856 and the dispenselocation workstation 868 connect and exchange Rx information directly with one another. - The dispense
location workstation 868 contains local executable program(s) that manage the call pickup, data acceptance, inventory management, and visually prepares the Rx information received from the interface application server in an easy to read queue for the local caregiver, typically a technician. In addition, the dispenselocation workstation 868 communicates with the co-located Remote Control Dispenser (RCD) 872 to dispense pharmaceuticals, aprinter 870, for example, a laser jet or color jet printer to provide patient and record keeping materials, as well as, a bar code scanner for doing quality checks during a dispense. The dispense location needs access to thetelephone service 864 to get a “dial tone” in order to receive and send communications. - The pharmacy control location is where the host pharmacy software is maintained or run. Typically these are small networks of pharmacy workstations where a retail or hospital pharmacy team interacts with insurer's computers to create the order that leads to the filling of a drug to be handed to the patient.
- The
interface application server 856 is a computer that is co-located with the host pharmacy software system. It is used to collect information (the Rx data) for a dispense from the host pharmacy system and then forwards that information to the dispenselocation workstation 868 via the telephone service, or thetelephone network 864. - Referring to FIGS. 13B and 13C, a typical workflow includes the sequence of steps illustrated. An Rx is generated by a physician or caregiver using a paperless method such as a PDA or TouchScreen or by usual methods using pen and paper, fax and scanners per
step 902. The Rx information typically contains the patient name, prescriber name and Drug Enforcement Agency identifiers, instructions for the administration of the drug, drug name, and quantity to be given to the patient. - The Rx is transmitted to different locations per
step 904. If the Rx is transmitted to a pharmacy control location via fax or an electronic means, the authorized dispenser, typically a pharmacist, interprets the transmitted information. If the Rx is transmitted to a dispense location electronically or physically delivered, a user, typically a technician can take authorized action. - The Rx is manipulated into the host pharmacy software system per
step 914 either by an authorized dispenser who interprets the Rx information transmitted directly to his/her location and then manually or through am electronic interface transfers the Rx information into the host pharmacy software or by the technician who has an option to transmit the information to the authorized dispenser, pharmacist, for the pharmacist to manipulate or to remotely connect to the host pharmacy software via a variety of interfaces to transfer the Rx information into the host pharmacy software system either manually or via an electronic interface. The connection interfaces can be, but are not limited to, Symantec pcAnywhere directly, Symantec pcAnywhere via the Internet, by a co-located WAN connection provided with the host pharmacy software. - Once the information is transcribed or transferred into the host pharmacy software system a number of typical processes are applied to the Rx information. The processes can be a Drug Utilization Review or an Adjudication process as described hereinbefore.
- The Rx information, having been processed by the host pharmacy software system can generally then be determined to be a valid Rx which can be processed by the pharmacist. In a retail setting the pharmacist then triggers patient drug labeling to be produced by the host pharmacy software system and takes a large bottle of medications from the shelf and counts and places into a smaller bottle, typically called a vial, the number of tablets, caplets, or milliliter's called for by the physician. The pharmacist then applies labeling and hands the drug to the patient.
- When the dispense is processed in conjunction with telepharmacy systems, the pharmacist or authorized dispenser triggers a patient drug label to be produced by the host
pharmacy software system 850, however, instead of the label being processed by a co-located printer 852 (laser jet or dot matrix) the output is directed to theinterface application Server 856. - The interface application server accepts the Rx information as a printer stream per
step 916, or through a direct electronic interface to the host pharmacy software system network constructs. An application, Parse Engine (PE), parses the output received by the host pharmacy software system into discreet data elements. Once the parsing is completed, the data is encrypted and is uniquely identified for transmission to the dispense location workstation via telephone service perstep 918. - The information is received by the dispense location workstation decrypted and placed into a work in process queue that is accessed by local executable programs run by the technician per
step 906. - The technician at the dispense location selects the Rx-Drug-Patient to be dispensed from a list of one or more possible to be displayed per
step 908. The selections are shown as mouse selectable lines. Each line represents a different RX-Drug-Patient to be processed by the technician. Upon selecting the Rx-Drug-Patient to dispense the technician at the dispense location is queried if this is in fact the RX-Drug-Patient perstep 920. - If the answer to the query is no, the technician is returned to the entire queue list as described above per
step 922. If the answer to the query is in the affirmative, the local executable program resident on the dispense location workstation examines a local inventory file that contains data specific to the drug requested to be dispensed perstep 924. The drug contains a profile which includes, but is not limited to, current stock level, suggested restock levels, and coordinate position within a single or plurality of RCD's. - The Remote Controlled Dispenser (RCD) receives a X,Y coordinate type communication from the locally resident executable. The X,Y coordinate represents a location within a single or plurality of RCD's where the requested pharmaceutical is stored for dispensing. The X,Y coordinate is determined by examining an inventory profile of the drug to be dispensed. Upon receiving the dispense signal from the dispense location workstation the RCD presents a drug to the technician per
step 926. - As a result of the dispense occurring, the technician is presented with an additional screen which requires the input of bar code data embedded onto the label of the dispensed drug. A bar code reader co-located at the dispense Location is used to read the bar code of the item dispensed from the RCD per
step 928. The technician reads the bar code into the screen to be examined by the resident dispensing software. - The bar code of the item dispensed is read into the resident dispensing software and is compared with the value of the bar code expected from the drug inventory profile. If the values match what resident dispensing software is expecting per
step 930, a patient education monograph, patient labeling, graphic representation of the drug expected, and picture of drug expected are generated and delivered to the co-located printer perstep 934. If the values do not match what the resident dispensing software is expecting, the user hasthree attempts with which to scan or enter the expected values perstep 932. If three failed attempts are made, the transaction is terminated with warnings sent to appropriate parties like the authorized dispenser, technician, system operator, and pharmacy consultant via pager and email. Appropriate drug disposal and storage is maintained via training of the technician and an additional lock storage box within the RCD. - The technician at the dispense location is presented with one additional bar code on the patient label that is to be affixed to the item dispensed. The technician is required to perform one more bar code read by scanning the patient label after it is affixed to the item dispensed per
step 936. The bar code of the item dispensed is read into the resident dispensing software and is compared with the a value of the bar code expected, the Rx number. If the values do not match what is expected, then the user has three attempts to scan the correct label before an error condition is reported perstep 940. If the values do match then the dispense is complete perstep 942 and the local technician is returned to the view of the queue showing work in process, if any. - If the patient, who has been remotely administered medications has any questions an authorized Pharmacist is available for consultation using a variety of telepharmacy systems, including, but not limited, to a telephone service audio visual connection, a networked audio visual connection, and an internet connected audio visual connection.
- FIGS. 14A and 14B illustrate the use of a
pager service 450 in combination with theInternet 320 to dispense medication from a remote location. Thepager service 450 interacts with theInternet 320 to transfer information between the host pharmacy system represented by thehost interface CPU 342 and thehost pharmacy workstation 344 and theremote dispensing system 324. A receive/send pager 452 interfaces with theRCD 324 and transfers information regarding the dispensing of medication. Aprint module 454 can be integrated with the RCD. FIG. 14B illustrates an embodiment having a dispenseinterface CPU 340 and alaser printer 444 co-located with theRCD 324. - In a preferred embodiment, a pager service can forward dispense information via an alpha/numeric page. A computer, such as, for example, but not limited to, an Aqcess Technologies Qbe Personal Computing Tablet, can be integrated with the RCD. In another preferred embodiment, the computing function can be accomplished using a combination of an external and integrated computer.
- FIGS. 15A and 15B illustrate a preferred embodiment which uses a
satellite system 460 to transfer information between a hostpharmacy interface CPU 342 and a remote dispensing system orRCD 324. TheInternet 320 transfers information fromhost interface CPU 342 to asatellite 460 via asatellite dish 462. The satellite in turn using a satellite send or receivemodule 464 transfers information to the dispenseinterface CPU 340 at a remote location from the host pharmacy system. The dispense interface CPU then directs the dispensing of medication from theRCD 324. As illustrated in FIG. 15B atouch screen computer 466 and aprint module 468 can be integrated with the RCD which eliminates the need for a dispenseinterface CPU 340. - In a preferred embodiment, the remote dispensing location is sent Rx dispense information via a satellite network, such as, for example, the Iridium paging or telephone network. The dispensing workflow remains the same, only the connectivity to the
RCD 324 changes. - According to another embodiment, a method of managing samples is a necessity in the highly regulated and cost control environment that exists in healthcare today. The current haphazard approach to sampling is both costly and inefficient for all parties concerned and provides little useful information to any party.
- The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is citing healthcare institutions for failure to document and manage pharmaceutical samples. Drug cost control is a critical factor and formulary management, via the sampling process, is an important component in that overall process, especially in outpatient and independent practitioner settings.
- The Joint Commission is citing hospitals and integrated delivery networks (IDNs) for failure to properly manage physician samples. The impact of a negative Joint Commission finding can be severe. Nonadherence with state and federal laws puts prescriber's licenses at risk, and violation of JCAHO-specified criteria in the drug sampling area can lead to a
Type 1 citation and endanger the healthcare organization's accreditation status. Many insurance companies and government programs, such as Medicare/Medicaid require JCAHO accreditation before they will reimburse that institution for medical care of its patients. - JCAHO requires the institutions to have a policy on drug samples and requires a control system that tracks the receipt and distribution of each drug sample. Further, the samples have to be properly labeled for patient use (including any auxiliary cautionary statements and expiration dates). The pharmacy department has to include drug samples in its process for responding to drug recalls and in its monthly inspection routine. This is the reason for tracking lot numbers and expiration dates. Drugs need to be stored so that unauthorized individuals do not have access to them, such as, for example, by using a locked cabinetry or room. JCAHO also requires the institution to keep a drug sample receiving log that tracks date, drug name, strength, form, lot number, manufacturer, received amount, expiration date of drug, and location of storage. In addition, JCAHO also requires either a drug dispensing log or a drug sample dispensing database that includes the following information date dispensed, patient name, drug name/strength/form, lot number, manufacturer, amount dispensed, directions for use, and physician name. The physician/pharmacist has to provide medication counseling per certain congressional regulations. This could be in the form of a drug monograph with the following information: name of medication, length of therapy, possible side effects of the medication, and expiration date and proper storage of the medication.
- Uncontrolled sampling is driving up costs for physicians, patients and payers of all kinds. Drug companies need alternatives which give them information, reduce costs and retain access to prescribing physicians.
- There are differing regulatory schemes in different jurisdictions that exist for drug samples and the dispensing thereof. The regulatory schemes address issues such as, for example, drug control license; patient's chart or clinical record to include record of drugs dispensed delegating authority to dispense drugs; storage of drugs; containers; labels; complimentary starter dose drug; information; inspection of locations; limitation on delegation; and receipt of complimentary starter dose drug's pharmacist. Further, the regulatory boards periodically inspect locations from which prescription drugs are dispensed.
- Under some regulatory schemes, a prescriber who wishes to dispense prescription drugs obtains from a board a drug control license for each location in which the storage and dispensing of prescription drugs occur. A drug control license is not necessary if the dispensing occurs in the emergency department, emergency room, or trauma center of a hospital or if the dispensing involves only the issuance of complimentary starter dose drugs.
- Per regulations, a dispensing prescriber can dispense prescription drugs only to his or her own patients. A dispensing prescriber has to include in a patient's chart or clinical record a complete record, including prescription drug names, dosages, and quantities, of all prescription drugs dispensed directly by the dispensing prescriber or indirectly under his or her delegatory authority. If prescription drugs are dispensed under the prescriber's delegatory authority, the delegatee who dispenses the prescription drugs has to initial the patient's chart, clinical record, or log of prescription drugs dispensed. In a patient's chart or clinical record, a dispensing prescriber has to distinguish between prescription drugs dispensed to the patient and prescription drugs prescribed for the patient. A dispensing prescriber has to retain information required for not less than, for example, five years after the information is entered in the patient's chart or clinical record.
- Regulations further include that a dispensing prescriber has to store prescription drugs under conditions that maintain their stability, integrity, and effectiveness and assure that the prescription drugs are free of contamination, deterioration, and adulteration. A dispensing prescriber has to store prescription drugs in a substantially constructed, securely lockable cabinet. Access to the cabinet has to be limited to individuals authorized to dispense prescription drugs in compliance with the regulatory schemes.
- Unless otherwise requested by a patient, a dispensing prescriber dispenses a prescription drug in a safety closure container that complies with the poison prevention packaging act, for example, of 1970, Public Law 91-601, 84 Stat. 1670.
- Further, a dispensing prescriber has to dispense a drug in a container that bears a label containing all of the following information: the name and address of the location from which the prescription drug is dispensed, the patient's name and record number, the date the prescription drug was dispensed, the prescriber's name, the directions for use, the name and strength of the prescription drug, the quantity dispensed, the expiration date of the prescription drug, or the statement required per regulations.
- Additionally, per the regulations, a dispensing prescriber who dispenses a complimentary starter dose drug to a patient has to give the patient at least all of the following information, either by dispensing the complimentary starter dose drug to the patient in a container that bears a label containing the information or by giving the patient a written document which may include, but is not limited to, a preprinted insert that comes with the complimentary starter dose drug, that contains the information: the name and strength of the complimentary starter dose drug, directions for the patient's use of the complimentary starter dose drug, and the expiration date of the complimentary starter dose drug.
- Per some regulations, a supervising physician may delegate in writing to a pharmacist practicing in a hospital pharmacy with a hospital licensed the receipt of complimentary starter dose drugs other than controlled substances. When the delegated receipt of complimentary starter dose drugs occurs, both the pharmacist's name and the supervising physician's name has to be used, recorded, or other wise indicated in connection with each receipt. A pharmacist may dispense a prescription for complimentary starter dose drugs written or transmitted by other means of communication by a prescriber.
- Per the regulations, “complimentary starter dose” means a prescription drug packaged, dispensed, and distributed in accordance with state and federal law that is provided to a dispensing prescriber free of charge by a manufacturer or distributor and dispensed free of charge by the dispensing prescriber to his or her patients.
- Referring to FIGS.16A-27D, a preferred embodiment of the present invention includes a way to manage the sampling process and provide solutions to the persistent regulatory compliance issues and escalating pharmaceutical costs. The embodiment fully documents the sample process and addresses all the JCAHO standards. The preferred embodiment also plays a significant role in better formulary management via information captured through the sampling process. The cost savings realized through this process benefit all constituents of the healthcare industry—patients, providers, and payers. Following are two examples of the preferred embodiment's contribution to controlling drug costs.
- Firstly, generic drug sampling can greatly reduce an overall pharmacy drug budget. A recent study, conducted by Scott & White Prescription Services, evaluated the cost savings achieved after implementation of a generic drug sampling program. Results showed savings per antibiotic prescription of over 10% of total prescription drug cost for antibiotics. Greater savings were shown for nonsteroidal anti-inflammatory medications. Drug sampling of nonsteroidal anti-inflammatories (NSAIDS) resulted in over 30% savings per prescription cost in this therapeutic category. Among the general conclusions of the study, generic drug sampling helped increase usage of generic medications and decrease average health plan cost per prescription, while allowing for opportunities to influence prescription habits.
- Secondly, drug sampling can selectively reduce medication costs for economically disadvantaged. In a study conducted al the University of Arizona Department of Pharmacy Practice and Science, it was determined that Medicare managed care beneficiaries adopted predictable behaviors to cope with capped prescription drug benefits. The findings suggest that a considerable proportion of Medicare managed care enrollees take steps (i.e. obtain a medication sample, take less than the prescribed amount of medication, and using an over-the-counter product to replace the prescribed medication) to avoid facing the full financial impact of their prescription drug costs.
- There are several benefits of the preferred embodiment in accordance with the present invention. The benefits are gained by physicians and pharmaceutical companies. For example, the pharmaceutical companies can get specific information about the prescriber, demographics on the patient without identification, competitive usage factors and site specific information using the preferred embodiment.
- Further, the distribution costs are lowered using the preferred embodiment of the present invention, enabling better use of the marketing representatives of the pharmaceutical companies. Lower wastage of samples due to strict controls over access and usage are realized with the preferred embodiment. Additionally, continued access to physicians is gained because the institution is able to meet accreditation standards. The preferred embodiment also provides the ability to get national rollout virtually overnight through information dissemination directly to users of sites employing the preferred embodiment. The preferred sample dispensing, is embodied by two components. A hardware component comprising uniquely designed cabinetry, and a touch screen software component.
- In the preferred embodiment, the software, for example, is written for
Microsoft® Windows 98 and Microsoft® Windows NT, using Visual Basic 6.0 and Visual C++, and runs on a typical Intel/Pentium based personal computer. Although disclosed with respect to being written for Microsoft® Windows, the software may be written for any computer operating systems, for example, JAVA platforms, UNIX system, Windows CE, and IBM OS operating systems. The operating requirements, imposed upon the personal computer are minimal, permitting the purchase of less expensive, though proven, computer components. Printers such as, for example, a Laser Jet or Color Ink Jet printer which provides a patient specific education monograph and labels with each dispense are used with the computer. The laserjet printer can also be used to print reports locally. Typical components include, for example, but are not limited to, ASUS motherboards, Intel Pentium II CPU's, 3COM 3C90X network interface cards, digital hard drives of between four and six gigabytes capacity, internal or external 3COM US Robotics modems, and MicroTouch touch screens. - The software is used by a nurse, physician, or medical office staff, depending upon state laws and regulations. The functionality of the software breaks down into five main categories, namely, dispensing function, loading function, maintenance, reports, and communications.
- All information transmitted, whether through the internet or a direct connection, is encrypted. An encryption program that is used, but not limited to, is for example, “Blowfish.” In addition, the key bit exceeds 128-bits for sites located within the United States. Any sites located outside of the borders of the United States will use key bit encryption strength approved by the US government, such as for example, 56-bit key lengths. According to some public safety regulations a key of 128-bit meets or exceeds the level deemed necessary to transmit information over the Internet or other electronic means.
- All information generated by the users input is captured in a transaction database for transmittal via the internet, or direct modem dial out, to a server. Inventory is maintained perpetually with increases to the stocking level managed via the load process, and decreases in inventory managed by the dispense process. Inventory stock levels are also communicated to a server, with special attention to stockout threshold levels to trigger additional communications with clinic managers, chiefs of pharmacy, manufacturers, and any others involved in the sample dispensing value chain.
- All information captured is aggregated in the server. The communications function of the samples dispensing software manages the aggregation process. At present time, throughout a 24 hour period, the communication module can deliver the days activity of an individual sample dispensing location to the server. This information is accumulated and is available for redistribution using a variety of ways and methods.
- Distribution of each sample dispensing location's information occurs in at least one of two ways, depending upon the available information infrastructure. Where telephone access is available the sample dispensing locations can call, using an800 number, a server, setup for receipt of up to 24 simultaneous connections. This type of server is commonly referred to as a Remote Access Server (RAS). The RAS can be set up with 24 ports or more capable of 56K connections using a T-1 data line. Additional simultaneous connections are available in groups of 24, 36, 128, or higher. If toll free access is not acceptable, the sample dispensing location can call a local Internet Service Provider access number, and then negotiate a session with the server also connected to the Internet.
- If modem access is not possible, then an existing hospital network running a protocol such as, for example, TCP/IP is used if that hospital can access the Internet. The sample dispensing location is connected to the hospital network to transmit daily activity logs through the hospital network, out onto the Internet, thence onto the server. The data is encrypted, and compressed so as to minimize the bandwidth necessary for each session. This reduction in bandwidth usage is important to many clinics, so that a drain on hospital networking resources is minimized, or as in the case of the information generated by the samples dispensing locations using modems is none.
- Methods of redistribution of samples include, but are not limited to, email, fax, website, and a planned integrated voice response(IVR)system. The server aggregates the information into a series of larger databases, while keeping information accessible that is unique to an installation by using a unique key for each individual location. In this manner, access to the information can be attained as an aggregate of a market, or as an individual dispensing location, depending upon the need. For example, Microsoft® SQL 6.5 acts as the main database repository engine.
- In a particular, preferred embodiment, for the server processes, Allaire's ColdFusion™ web site database management and development solution can be used. Allaire is a web site development language and solution company with tools for data management over the Internet. Other database management and development solutions can be used. Each customer is offered a unique view of the aggregated data based upon the customers buying level.
- Using password access, the preferred embodiment offers a user nearly real time sample dispensing information. In addition, based upon buying levels, daily, weekly, or monthly reports via email are provided.
- In another preferred embodiment, a process that can be broken up into a series of questions that can be responded to using a telephone keypad is programmed using an IVR. A follow-on device can be provided for patients to interact with regard to their prescriptions. Medications used for treating various mental incapacities have a history of side effects ranging from mild to severe. These medications are typically quite expensive. In cases of severe side effects, the patient's entire prescription is destroyed and another new and different prescription is generated. The destroyed medications are a complete loss to the dispensing institution and the patients' insurer. Using samples, and an IVR system, a complete costly prescription is not given to a patient until the patient has completed a duration of free samples to determine if side effects are severe enough to warrant a different therapy approach.
- A patient can query a prearranged IVR number to indicate that side effects are, or are not, present in his or her currently selected therapy regime. If the patient can tolerate the tested samples, then the IVR can trigger the hospital pharmacy, an online pharmacy company like, for example, PlanetRx.com, or redirect the Rx to a mail order facility, a complete therapy cycle based upon the norms of the institution. Where an expensive prescription might have been wasted the patient can test a free sample of the medication before determining if a complete cycle of therapy would be effective without severe side effects.
- A user, instead of dialing an IVR system, launches their favorite web browser using an Internet service such as, for example, AmericaOnLine or any other Internet access provider, and complete a series of simple questions about the sample of medicine, before being issued a complete therapy cycle. The therapy cycle can be redirected to many different locations, including, again the originating hospital outpatient pharmacy, a mail order house, etc.
- FIGS. 16A through 22 illustrate embodiments of screens of the software component of the sample dispensing. The screens can be displayed by a monitor of a drug dispenser. In a preferred embodiment, the monitor is a touch screen. Therefore, it is possible for a user to interact with the dispenser by using the monitor and the screens shown in FIGS. 16A through 22 to provide commands to the
dispenser 1500. To use the touchscreen monitor, the user must press the tip of a capacitive item, such as a finger against the screen. Non-capacitive items, such, as fingernails or pointed objects, will not work. In another embodiment, the user can also use a mouse or a keyboard to interact with the commands and options presented on the screens. - FIGS. 16A through 16E illustrate a method of dispensing drug samples from the
sample dispenser 1500 and embodiments of screens associated with dispensing samples. FIG. 16A shows anintroduction screen 1400 having a dispensecommand 1402 and amaintenance command 1404. To engage the dispenser to dispense drugs, the user can select the dispensecommand 1406. The user can then be presented with asubscriber name screen 1408, as shown in FIG. 16B. The user can select the first initial of the prescriber'slast name 1410 usingletter keys 1412. The user can then select theprescriber name 1414 from thescreen 1408. Next, the user types in thepatient name 1416 in a patient name area. Theuser can then proceed 1420 by selecting; anext command 1426. - FIG. 16C shows a
medication screen 1422 which can follow thesubscriber name screen 1408. A user can select the first letter of amedication 1424 he wishes to receive using theletter buttons 1412 provided. A list of medications can then be listed on thescreen 1422. The user can select themedication 1428 he requires by touching the portion of the screen corresponding to his drug choice. The user can select the number of packages he requires 1430 using thepackage quantity buttons 1432. The number of packages is not equivalent to the number of doses needed for a patient, since one package can have multiple doses of medication. The user can then proceed 1434 by selecting thenext command 1426. - FIG. 16D shows a
SIGS screen 1442 which can follow themedication screen 1422. The user can select one of the provided SIGS or use he space at the bottom to create acustom SIG 1436. The user can edit both the lot number andexpiration date 1438 of the medication. The user can then proceed 1440 by selecting anext command 1426. The user can then be presented with a dispensesummary screen 1442, shown in FIG. 16E. The user can then review all entries to make sure they are correct 1444. The user can also check the printer to ensure that paper is available 1444. The user can chose to give the same patientadditional medications 1446, restart theprocess 1448 or select a finish command to print labels and monographs for thepatient 1450. - FIGS. 17A through 17C illustrate a method of loading medications into a dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404, shown in FIG. 17A. The user can select themaintenance command 1446 to proceed with the loading of medications. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select theload command 1458 to proceed. The user can then be presented with auser identification screen 1460 where the user can enter his name and his company's name before proceeding. After the data has been entered, the user can select anext command 1462 to continue. - FIG. 17B illustrates a
medication screen 1464, which follows theuser identification screen 1460. The user can select the first letter of the medication to be loaded 1466 from theletter buttons 1412. The user can then be presented with a list of drugs having names starting with the chosen letter. The user can then select the medication to be loaded 1468 from thescreen 1464. The user can proceed by selecting a next command 170, which brings him to amedication data screen 1472, shown in FIG. 17C. In themedication data screen 1472, the user can enter the lot number, the expiration date and the quantity of the medication added 1474 to the dispenser. Themedication data screen 1472 includes asave command 1476 and a quit—nosave command 1478. After entering the data and hitting the tab key to move through the screens, the user can check his entries and execute the save command if they are correct or execute a the quit—no save command if they are incorrect 1480. - FIGS. 18A through 18D illustrate a method to view or edit inventory within the dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404, shown in FIG. 18A. The user can select themaintenance command 1446 to proceed with the loading of medications. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select the databases command 1482 to proceed. Adatabase screen 1484 can then be presented to the user as illustrated in FIG. 18B. - The
database screen 1484 can include aninventory command 1486, aprescriber command 1487, atransactions command 1488 and aload command 1489. To view or edit inventory in the dispenser, a user can select the inventory command 1490 and select a medication 1492 shown on thescreen 1484. Thescreen 1484 can present manufacturer and bar code information of the medications, in addition to medication names. The user can then manipulate theinventory database 1494 by either editing or deleting the database selection. When editing the database selection, an inventorydatabase editor screen 1495 can appear, as shown in FIG. 18C. On thisscreen 1495, the user can edit items or add new items to thedatabase 1496. To add new items to the database, the user can select theinventory command 1486, select theedit command 1330 and select a medication from thescreen 1484. Any medication can be selected since it will immediately be changed. The user can then select the clear all fields command 1332, enter data into the blank fields shown on thescreen 1495 and select thesave command 1334. - The user can opt to get new GCN number and apply the
new GCN number 1498 from the inventorydatabase editor screen 1495. A GCN number is assigned to drugs that belong in the same class and can be used to create a monograph that the patient receives in the dispense process. If the use chooses to get and apply a new GNC, the user can be presented with aGCN screen 1300, shown in FIG. 18D. From this screen, the user can select a new GCN number by picking the actual medication or its closest therapeutic equivalent from thescreen 1300. Whichever item is selected will have its GCN number added to theNEW GCN textbox 1306 on the inventorydatabase editor screen 1495. The user can return to the inventorydatabase editor screen 1308 and choose to save the new data or restore theprevious data 1310. - FIGS. 19A through 19C show a method to view or edit a prescriber within the database of the dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404, shown in FIG. 19A. The user can select themaintenance command 1446 to proceed with the loading of medications. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select the databases command 1482 to proceed. Adatabase screen 1484 can then be presented to the user as illustrated in FIG. 19B. - The
database screen 1484 can include aninventory command 1486, aprescriber command 1487, atransactions command 1488 and aload command 1489. To view or edit a prescriber in a database interfaced with the dispenser, a user can select theprescriber command 1310 and select aprescriber 1312 shown on thescreen 1484. The user can then remove the selected prescriber from the database or edit the prescriber information to add him to the database 1314. If the user chooses to add a new prescriber, he can be presented with a prescriberdatabase editor screen 1316, shown in FIG. 19C. The user can enter a new prescriber name and return to thedatabase screen 1318. - FIGS. 20A and 20B illustrate a method to view a transaction made with the dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404, shown in FIG. 20A. The user can select themaintenance command 1446 to proceed with the loading of medications. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select the databases command 1482 to proceed. Adatabase screen 1484 can then be presented to the user as illustrated in FIG. 20B. - The
database screen 1484 can include aninventory command 1486, aprescriber command 1487, atransactions command 1488 and aload command 1489. To view the transactions made with thesample dispenser 1500, a user can select thetransaction command 1320. The transaction database can be used for viewing purposes only. The user can view the transactions by transaction number or by transaction date, for example. - FIG. 21 illustrates a method viewing the load history of the dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404. The user can select themaintenance command 1446 to proceed with the loading of medications. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select the databases command 1482 to proceed. Adatabase screen 1484 can then be presented to the user. - The
database screen 1484 can include aninventory command 1486, aprescriber command 1487, atransactions command 1488 and aload command 1489. To view the database showing the medications loaded into the dispenser, a user can select theload command 1322. The database showing the medications loaded can be used for viewing purposes only. Thedatabase screen 1484 can show various types of load data, including load date, drug potency, and quantity. - FIG. 22 illustrates a method of viewing reports of the database of the dispenser. The user can first be presented with an
introduction screen 1400 having amaintenance command 1404. The user can select themaintenance command 1446 to proceed with the viewing of reports. The user can then be presented with amenu screen 1448 having aload command 1450, adatabases command 1452, areports command 1454 and a return tointroduction screen command 1458. The user can select the reports command 1324 to proceed. A reports screen 1326 can then be presented to the user. The user can then select areport 1328 from thescreen 1326 that lie wishes to view. For example, an inventory report can be chosen and viewed by the user. - FIGS. 23A and 23B show a preferred embodiment of a
sample dispenser 1500 the hardware system of sample dispensing. Thedispenser 1500 can have acomputer 1560 located within acomputer housing 1502, amonitor 1504, aprinter 1506 and acontrol system 1518 located within acontrol system housing 1546. Thedispenser 1500 can also havedoors 1508 holding a plurality ofbins 1510, acamera 1512 and auser identification system 1514. FIG. 23A shows adoor 1508 of thedispenser 1500 in an open position. FIG. 16B shows adoor 1508 of thedispenser 1500 in a closed position. - FIGS. 24A and 24B illustrate an embodiment of the
computer housing 1502 in an open and a closed position, respectively. Thecomputer housing 1502 can be opened and closed in order to allow restricted access to the computer for rebooting or servicing. Thecomputer housing 1502 can have astationary portion 1562 and amoveable portion 1564. The stationary 1562 and moveable 1564, portions can be attached by at least onehinge 1566. In a preferred embodiment, twohinges 1566 connect the stationary 1562 and moveable 1564 portions of thehousing 1502. Themoveable portion 1564 of thehousing 1502 can includeside rails 1568 and thestationary portion 1562 of thehousing 1502 can haveside walls 1570. Therails 1568 andwalls 1570 can limit the motion of themoveable portion 1564 and thecomputer 1560 as themoveable portion 1564 is opened by a user. When themoveable portion 1564 is opened, theside rails 1568 can engageside walls 1570 of thestationary portion 1562 of thehousing 1502, thereby preventing further rotation of themoveable portion 1564 of thehousing 1502. Opening thecomputer housing 1502 can allow user access to thecomputer 1560. - FIG. 25 shows a
computer 1560 mounted on amoveable portion 1564 of ahousing 1502. In one embodiment, thehousing 1502 can havepistons 1570 or dampeners mounted between themoveable portion 1564 and thestationary portion 1562. In the embodiment shown, thepistons 1570 can be mounted betweenmovable portion brackets 1574 andstationary portion brackets 1576. Thepistons 1570 can help to control the speed at which themoveable portion 1564 travels when thecomputer housing 1502 is opened. - The
computer housing 1502 can have acomputer 560 which can include a motherboard, a CPU, a network interface card, a hard drive and a modem. In a preferred embodiment, thecomputer housing 1502 can include an Asus motherboard, an Intel Pentium™ II CPU, a 3Com 3C90X network interface card, a Western Digital hard drive and a 3Com U.S. Robotics modem. The hard drive can have between a 4 and 6 gigabyte capacity, for example. The modem can be either an internal or an external modem. Themonitor 1504, in a preferred embodiment, is a touch screen such as, for example, a MicroTouch screen which allows users to enter commands into the computer. The computer can also include a keyboard to allow commands to be entered into the computer. Theprinter 1506 can be a laser jet or a color ink jet, for example. - A
camera 1512 can be mounted to thedispenser 1500, as shown in FIGS. 23A and 23B, and can be used to create a photographic record of all users of thesample dispenser 1500. Such a record can be used for security at thesample dispenser 1500 and to discourage tampering at thedispenser 1500. Thecamera 1512 can be triggered by some predetermined event to automatically take a picture of the area surrounding the dispenser. In one embodiment, a proximity sensor can be electronically coupled to thecamera 1512 and can cause thecamera 1512 to snap a picture based upon some external event. For example, if a user were to move within a certain distance of thedispenser 1500, the proximity sensor detects such a motion and causes thecamera 1512 to automatically capture an image of an area surrounding thedispenser 1500. In another embodiment, thecamera 1512 can be coupled with theuser identification system 1514 such that engaging thesystem 1514 causes thecamera 1512 to take a picture. For example, if a user were to attempt to use theidentification system 1514, either successfully or unsuccessfully, such an attempt triggers thecamera 1512 to snap a photograph. In another embodiment, thecamera 1512 can be connected with thedoors 1508 of thedispenser 1500 such that opening thedoors 1508 causes thecamera 1512 to snap a picture of an area surrounding thedispenser 1500. Thecamera 1512 can have a control system which can be a computer. The computer which controls thecamera 1512 can be separate from the computer which controls thedispenser 1500 or integrated with it. - The
sample dispenser 1500 can also have auser identification system 1514 to protect against unauthorized access. Theuser identification system 1514 can be used as a security device to permit authorized user access to the medications dispensed by the dispenser. In thissystem 1514, a user would be required to provide some paper form of identification to thesystem 1514 before thedoors 1508 of thedispenser 1500 could be opened. Theuser identification system 1514 can be used in conjunction with a locking mechanism to provide security for thedispenser 1500. In one embodiment, theuser identification system 1514 operates by identifying a fingerprint of a user. In a preferred embodiment, theuser identification system 1514 operates by identifying a thumb print of a user. To access thedispenser 1500, a user places a finger or a thumb against theuser identification system 1514. If the user's fingerprint was recognized by theuser identification system 1514, a locking mechanism in thedispenser 1500 is released and thedoors 1508 opened. If the user's fingerprint was not recognized by theuser identification system 1514, the locking mechanism in the dispenser is not be released, thereby preventing access to the samples in thedispenser 1500. Theuser identification system 1514 can have a control system which can be a computer. The computer which controls theuser identification system 1514 can be separate from the computer which controls thedispenser 1500 or integrated with it. It should be noted that the user identification system can include, but is not limited to, hospital identification cards, credit card, debit card, other identification paperwork, keyword or password access using a keypad. - The
sample dispenser 1500 can also havedoors 1508. Thedoors 1508 can house a plurality ofbins 1510 which can be used to contain or organize samples within thedispenser 1500. Eachdoor 1508 can be connected to the dispenser by ahinge 1516. - FIG. 26A shows a
control system 1518 for thedoors 1508. Thecontrol system 1518 can include abelt 1520 having at least oneblock 1524 attached therein and having a set ofrollers 1522 to control the motion of thebelt 1520. In one embodiment, theblocks 1524 are bolted to thebelt 1520. In another embodiment, thebelt 520 is a chain drive. In one embodiment, therollers 1522 can be gears. Therollers 1522 can be connected to a control system which can control the motion of therollers 1522, thereby providing automatic opening and closing of thedoors 1508. The control system can include a computer. - Each
door 1508 can be connected to afirst end 1532 of arod 1530 at apivot 1528 on thedoor 1508. Asecond end 1534 of eachrod 1530 can be attached to apivot 1526 on eachblock 1524. Therods 1530 connect thedoors 1508 to themotion control system 1518. Thepivots 1528 on thedoors 1508 allow thedoors 1508 to rotate about theirhinges 1516 without impingement from therods 1530. Similarly, thepivots 1526 on theblocks 1526 allow therods 1530 to follow the rotational motion of thedoors 1508 without impinging this motion. - FIG. 26A also shows the
control system 1518 in various stages of operation. Thecontrol system 1518 can control the positioning of thedoors 1508. In afirst stage 1536, thedoors 1508 are in a closed position, with aside door portion 1544 forming a zero degree angle with acenterline 1542. Theblocks 1524 are located on thebelt 1520 near thecenterline 1542 of thecontrol system 1518. Thebelt 1520 causes therods 1530 to create a force on eachdoor 1508 directed toward thecenterline 1542, thereby holding thedoors 1508 in a closed position. In asecond stage 1538, thedoors 1508 are half-opened, with aside door portion 1544 forming a forty-five degree angle with thecenterline 1542. In thisposition 1538, eachblock 1524 is forced to move away from thecenterline 1542 of thesystem 1518 by thebelt 1520, in an opening motion, or forced to move toward thecenterline 1542 of thesystem 1518 by thebelt 1520, in a closing motion. In an opening motion, thebelt 1520 causes eachrod 1530 to create a force against eachrespective door 1508, directed away from thecenterline 1542, thereby forcing thedoors 1508 in a partially open position. In a closing motion, thebelt 1520 can cause eachrod 1530 to create a force on eachrespective door 1508, directed toward thecenterline 1542, thereby forcing thedoors 1508 in a partially open position. In athird stage 1540, the doors are fully opened, with aside door portion 1544 forming a ninety degree angle with acenterline 1542. In thisposition 1540, eachblock 1524, again, has been forced to move away from thecenterline 1542 of thesystem 1518 by thebelt 1520. The motion of thebelt 1520 to thisposition 1540 further causes eachrod 530 to create a force against eachrespective door 1508, directed away from thecenterline 1542, thereby, forcing thedoors 1508 into a fully open position. - The
motion system 1518 can be operated automatically. Such operations can provide security for thedispenser 1500 and can limit user access to thedevice 1500. When operated, thecontrol system 1518 can cause thedoors 1508 to expand or contract to an open or closed position, respectively. Automatic operation of thecontrol system 1518 can be triggered by some predefined event. For example, in one embodiment, thedoors 1508 can be programmed to be opened by themotion control system 1518 only when the user provides positive identification. Also, thedoors 1508 can be programmed to automatically close after a set time period has elapsed. In another embodiment, thedoors 1508 can also be caused to close when the user moves away from a proximity sensor located on thedispenser 1500. For automatic operation of thecontrol system 1518, thesystem 1518 can be controlled by a computer. The computer which controls thesystem 1518 can be separate from the computer which controls thedispenser 1500 or integrated with it. - The
sample dispenser 1500 can also include a bar code reader, or an electronic reader in an alternate embodiment. The samples held by the plurality ofbins 1510 can include bar codes. The inclusion of a bar code reader on thesample dispenser 1500 can allow a user to quickly and accurately create a record of the samples removed from thesample dispenser 1500 and the dates and times of removal, for example. - FIG. 26B illustrates a detailed, overhead view of the
control system 1518 shown in FIG. 26A. Thecontrol system 1518 can have ahousing 1550 to which thebelt 1520,rollers 1522 andblocks 1524 are mounted. Thehousing 1550 can also hold and secure thesecomponents control system housing 1546. Thehousing 1550 can haveflanged portions 1552 which allow for attachment of thehousing 1550 to thecontrol system housing 1546. Thecontrol system 1518 can also have a shank 1554 attached to thehousing 1550. Eachblock 1524 can have a groove formed therein such that the groove in eachblock 1524 mates with the shank 1554. Theblocks 1524 can be mounted on the shank 1554 such that theblocks 1524 can slide along the length of the shank 1554. In a preferred embodiment, the shank 1554 is a raised steel rod. - FIGS. 27A through 27D illustrate an embodiment of a
bin 1608 for asample dispenser 1500. Thebins 1608 can be used to store and organize drugs within thedispenser 1500. In the embodiment shown, thebin 1608 have ahousing 1614 with afront end 1610 and aback end 1612. Thehousing 1614 includes ahandle 1620, a pushingdevice 1616 and acontinuous torsion spring 1618. Thehandle 1620 is used to aid in removing thebin 1608 10 from thedispenser 1500. When thebin 1608 is empty, the pushingdevice 1616 is forced to thefront end 1610 of thebin 1608 by thecontinuous torsion spring 1618. A user can then load medicines or drug packages into thebin 1608 by moving the pushingdevice 1616 to theback end 1612 of thebin 1608. Such motion provides storage space for the medicine and extend thecontinuous torsion spring 1618. As drug packages are removed from thebin 1608, the pushingdevice 1616 is forced toward thefront end 1610 of thebin 1608 by the contractingcontinuous torsion spring 1618. In this embodiment, the user can know immediately whether abin 1608 is empty or full. Incrementing a second drug package to thefront end 1610 of thebin 1608 when a first drug package is removed ensures that a package will always be readily available. Such a unit can save the user time in guessing whether a bin is entirely empty or contains a package “hidden” in the back of a bin. - In another preferred embodiment, a drug dispenser dispense non-prescription, over-the-counter drugs to patients who can positively identify themselves to the drug dispenser system. FIGS. 28 through 34 illustrate embodiments of user interactive touch screens which can be used with such a system. The screens can provide a way for a user to interact with the software at the non-prescription dispenser.
- FIG. 28 shows an
introduction screen 1560 for a touch screen monitor of a non-prescription drug dispenser. Theintroduction screen 1560 can include astart command 1562,language option command 1564 and ademonstration command 1566. Thestart command 1562 can allow a user to progress through subsequent screens and choose the non-prescription drugs they wish to receive. Thelanguage option command 1564 allow a user the choice of language for subsequent display screens. Thedemonstration command 1566 can provide a demonstration of how the drug dispenser works. Theintroduction screen 1560, and all subsequent screens, can include anend command 1568 which allows a user to exit the screens at any point. - FIG. 29 illustrates a drug
category selection screen 1570 havingdrug category selections 1572 and areset command 1574. Thedrug category selections 1572 allows a user to select the drug categories from which they would like to receive products. The drug categories can include medications for allergies, antacids, cold/flu, creams/lotions, hemorrhoids, laxatives, pain relievers and vitamins, for example. Thereset command 1574 allows the user to start over or cancel his selection, if the wrong selection had been made. - FIG. 30 illustrates a
drug availability screen 1576 showing the availability of different dugs within a selected category. If a user selected Pain Relievers as a drug category, the screen shown in FIG. 30 can provide the user with a list of the types of pain relievers available. For example, under the pain relievers category, a user can choose from aspirin, children's aspirin, acetaminophen, ibuprofen or non-aspirin acetaminophen. The user can choose the drugs he wishes to receive, using the drug selection commands 1578. Eachdrug selection command 1528 can be associated with a particular drug. Thedrug availability screen 1576 can also have adrug list command 1580 which, when activated, can show the user a list of all of the drugs he has selected. - FIG. 31 shows a
drug list screen 1582 which lists the user's selection ofdrugs 1588. Thedrug list screen 1582 can include drug selection commands 1598 which allow a user to delete certain drug choices from the list. In one embodiment, to delete a drug choice, a user can touch a drug selection commands 1598 corresponding to the drug to be removed from the list. Thedrug list screen 1582 also shows a “continue”command 1584 and a “done”command 1586. The “continue”command 1584 allows the user to make further drug selections. The “done”command 1586 allows the user to exit the drug selection screens and receive the drugs he has chosen. - FIG. 32 illustrates a user identification screen1590. This screen 1590 instructs the user to identify himself to the drug dispensing system, in order for the drugs to be dispensed. In one embodiment, the user can be instructed to swipe his Veteran's Administration card through a card reader. The information on the user's card can then be compared to information within the system's database to determine the user's eligibility to receive the requested drugs. The user identification screen 1590 can also include user
identification indicator buttons 1592. Thebuttons 1592 can include apositive identification button 1594, which indicates the user's identification as valid, or anegative identification button 1596, which indicates the user's identification as invalid. - FIG. 33 shows a ready-to-dispense screen1600 which can indicate the drugs the user has selected and will be dispensed. The ready-to-dispense screen 1600 can also include drug selection commands 1602 which allow a user to delete certain drug choices from the list. In one embodiment, to delete a drug choice, a user can touch a portion of the touch screen corresponding to a
drug selection command 1602 which, in turn, corresponds to the drug to be removed from the list. The ready-to-dispense screen 1600 can also have a drug dispense command 1604. When a user is satisfied with his drug request, he can touch this button to begin the drug dispensing procedure. - FIG. 34 shows an
ending screen 1606. Theending screen 1606 can provide instructions to the user involving picking up drugs from the dispenser tray and taking information from the printer. The endingscreen 34 can also indicate to the user that the request is being processed and delivered. - FIGS. 35 and 36 illustrate an embodiment of an over-the-counter (OTC)
medication dispenser 1650. TheOTC medication dispenser 1650 can have a housing 1684 which includes adoor 1652,drug storage trays 1654, alabeling device 1656,electronics 1658, auser identification system 1660, acomputer 1666, asecurity monitoring device 1668, amagnetic card reader 1672 and apickup location 1674. Thecomputer 1666 can include adisplay 1662 and aprinter 1664 having apaper pickup location 1674. Thedisplay 1662 can be a touch screen display. The display screen can display materials such as, for example, advertisement material pertinent to the non-prescription drugs or related educational material. Thedoor 1652 is shown in an open position to better illustrate thedrug storage trays 1654 of themedication dispenser 1650. - Both the
user identification system 1660 and themagnetic card reader 1672 can be used to either permit or prevent a user's access to themedication dispenser 1650. Theuser identification system 1660 can be a fingerprint reader and, preferably, is a thumb print reader. However, other user identification systems can be incorporated, such as, for example, but not limited to, credit card, debit card, and smart card reader systems. Theuser identification system 1660 can compare the user's fingerprint data against fingerprint data contained in a database interfaced with thedispenser 1650. Themagnetic card reader 1672 can read information from a user's medication dispenser card, such as a Veteran's Administration card, and compare the information to that within a database interfaced with thedispenser 1650. In either theuser identification system 1660 or themagnetic card reader 1672, if the user's information is present in the database, the user will be allowed to proceed and can receive his requested medication. Conversely, if the user's information is not located in the database, the user will not be able to proceed within the system or receive any medication. Adispenser 1650 can include either theuser identification system 1660 or themagnetic card reader 1672, or both, depending upon the level of security required by the customer. For example, adispenser 1650 located in a doctor's office can require a different level of security than adispenser 1650 located in a methadone clinic. For customer's requiring a high level of security, thedispenser 1650 can include both theuser identification system 1660 and themagnetic card reader 1672. - The
electronics 1658 can include a camera, speakers or a microphone. The speakers or microphone can allow for user interaction with thecomputer 1666 with the presence of a voice recognition system. The camera can be connected to thesecurity monitoring device 1668. Thesecurity monitoring device 1668 can detect tampering of thedispenser 1650. In one embodiment, thesecurity monitoring device 1668 can be an infrared detector. In another embodiment, thesecurity monitoring device 1668 can be a vibration recorder. If thedispenser 1650 was tampered, the security monitoring device could cause the camera to create a photographic record of the area surrounding thedispenser 1650, for example. In one embodiment, the photographic record could be a digital image which could then be transferred to a monitoring station, byway of modem technology, for example. - The
drug storage trays 1654, as shown in FIG. 36, can include a dispensing device. In a preferred embodiment, the dispensing device can include helix coils 1680. In a preferred embodiment, the helix coils 1680 are motor driven and allow the dispensing of medications to a user. When a user selects a medication to be dispensed from thedispenser 1650, thehelix coil 1680 corresponding to the chosen medication can be forced to rotate, thereby causing the medication to move toward thedoor 1652 of thedispenser 1650 and into acollection tray 1676 located on thedoor 1652. Thedrug storage trays 1654 can also includedividers 1682. Thedividers 1682 can be adjustable within thetrays 1654 such that thetrays 1654 can accommodate medication packages of varying sizes or shapes. The rotation of the helix coils 1680 can be controlled by some control system, such as a computer for example. - The
door 1652 can be used to secure thedrug storage trays 1654 and the medications within the housing 1684 of theOTC medication dispenser 1650. Thedoor 1652 can includelifting mechanisms 1678, which are shown without thedoor 1652 in FIG. 37. Thedoor 1652 can also include acollection tray 1676, a pushingdevice 1686 and a pushingdevice control 1688. - In a preferred embodiment, the lifting
mechanisms 1678 are S-rail lifting screws. The S-rail lifting screws can be threaded through thecollection tray 1676 and can rotate about a central axis, either in a clockwise or a counterclockwise direction, thereby causing thecollection tray 1686 to translate in an upward or downward direction. The S-rail lift screws can also be Teflon coated to provide for smooth translation of thecollection tray 1676. - The
collection tray 1676 can be used to collect medicine packages from thedrug storage trays 1654 and deliver the packages to thelabeling device 1656. By allowing for thecollection tray 1676 to translate upwards and downwards, thetray 1676 can collect medicine packages fromdrug storage trays 1654 located along the entire height of thedispenser 1650. Positioning thecollection tray 1676 at a particulardrug storage tray 1654 from which a package is being dispensed prevents the medicine in the package from being damaged by an impact after being dispensed. The positioning at thecollection tray 1676 can be controlled by a control system, such as a computer, for example. - The
collection tray 1676 can include a pushingdevice 1686 which can be used to move medical samples from thecollection tray 1676 into thelabeling device 1656. The pushingdevice 1686 can include a pushingdevice controller 1688 which controls the positioning of the pushingdevice 1686. In one embodiment, the pushingdevice controller 1688 is an S-rail screw. In another embodiment, a conveyor can be used as the pushingdevice controller 1688. The pushingdevice controller 1688 can be driven by a control system, such as a computer, for example. - When a user wishes to retrieve drugs from the
OTC medication dispenser 1650, he can first be prompted to provide his identification, either by utilizing theuser identification system 1660 or themagnetic card reader 1672, or both and can then enter his medication choices into thecomputer 1666. In another embodiment, the user can first be prompted to enter his drug choices and then be required to provide his identification to thedispenser 1650. Next, thecollection tray 1676 can be forced to move, in either an upward or downward direction, to thedrug storage trays 1654 which contain the requested medication. The helix coils 1680 can then be forced to rotate in thedrug storage trays 1654 so as to advance the selected medication into thecollection tray 1676. Thecollection tray 1676 can then be caused to move upwards or downwards to thelabeling device 1656. The pushingdevice 1686 of thecollection tray 1676 can then be caused to push the medication from thecollection tray 1676 into thelabeling device 1656. In thelabeling device 1656, the drug can be identified by a bar code reader which can read the medication's bar code. Thelabeling device 1656 can also apply a label to the medication. Thelabeling device 1656 can then transfer the medication to thepickup location 1674. In a preferred embodiment, thelabeling device 1656 can transfer the medication to thepickup location 1674 by a conveyance mechanism, such as an S-rail or a conveyor. In a preferred embodiment, thepickup location 1674 can have a cover which can be automated. When the medications arrive at thepickup location 1674, as requested by the user, the cover can open. Once the user removes the requested medications, the cover can automatically close and secure itself to thepickup location 1674. - Without limiting the generality of the claimed invention, those skilled in the art can appreciate that the components of the dispensing system—physical and program code—can be physically split and operated from different locations, connected together by a computer network. Further, components of the system can be divided and owned and operated by multiple entities, connected by a computer network if applicable.
- It will be apparent to those of ordinary skill in the art that methods involved in the remote dispensing of pharmaceuticals or other medical products can be embodied in a computer program product that includes a computer usable medium. For example, such a computer usable medium can include a readable memory device, such as a hard drive device, a CD-ROM, a DVD-ROM, or a computer diskette, having computer readable program code segments stored thereon. The computer readable medium can also include a communications or transmission medium, such as a bus or a communications link, either optical, wired, or wireless, having program code segments carried thereon as digital or analog data signals.
Claims (20)
1. A method for dispensing medical sample products from a sample dispenser comprising the steps of:
storing a plurality of medical sample products in a sample dispenser;
verifying a user's identification and ability to receive medical sample products from the sample dispenser;
using a control system to provide user access to the plurality of medical sample products in the dispenser, the control system actuating movement between a closed position and an open position;
removing a subset of the plurality of medical sample products from the dispenser in the open position and recording the subset of medical sample products into a database;
generating a monograph for a patient; and
using the control system to secure the sample dispenser in the closed position such that further user access to the medical sample products is prevented.
2. The method for dispensing medical sample products of claim 1 , wherein the monograph includes at least one of patient specific information, directions for use, name and strength of a prescription drug, warnings, possible side effects and quantity dispensed.
3. A medical sample product dispenser comprising:
a housing;
a plurality of storage bins mounted within the housing, the plurality of storage bins containing a plurality of medical sample products;
a control system operably coupled to the housing to control user access to the dispenser, the control system actuating movement between a closed and an open position;
a computer mounted within the housing;
a user identification system mounted to the housing; and
a monograph generating device mounted to the housing.
4. The medical sample product dispenser of claim 3 , wherein the computer is in communication with a database data processor.
5. The medical sample product dispenser of claim 4 , wherein the database data processor is accessed by a plurality of manufacturers of the medical sample product dispenser.
6. The medical sample product dispenser of claim 3 , wherein the medical sample product dispenser further comprises at least one door mounted to the housing, at least one door having a plurality of bins.
7. The medical sample product dispenser of claim 3 , further comprising a proximity sensor.
8. The medical sample product dispenser of claim 3 , further comprising a label dispenser.
9. The medical sample product dispenser of claim 3 , wherein the computer is connected to a communication network.
10. The medical sample product dispenser of claim 3 , further comprises an actuator to open and close doors on the dispenser.
11. The medical sample product dispenser of claim 3 , wherein the computer is in communication with a server.
12. The medical sample product dispenser of claim 9 , further comprising an internet connection.
13. A system to connect to medical product package dispenser comprising:
wireless communication device; and
a dispensing system having a wireless port; the wireless communication device being in wireless communication with the dispensing system to actuate dispensing of packaged medical products.
14. The system of claim 13 , wherein the wireless communication device comprises a satellite system.
15. The system of claim 13 , wherein the wireless communication device comprises a pager system.
16. The system of claim 13 , wherein the wireless communication device comprises a personal digital assistant.
17. The system of claim 13 , wherein the wireless communication device is in communication with a communication network.
18. The system of claim 13 , further comprising a controlling data processor in communication with the wireless communication device.
19. The system of claim 18 , wherein the controlling data processor and the wireless communication device communicate via a network.
20. The system of claim 13 , wherein the packaged medical product is a prescription pharmaceutical.
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Also Published As
Publication number | Publication date |
---|---|
CA2383290A1 (en) | 2001-03-29 |
WO2001021131A3 (en) | 2002-09-26 |
US6564121B1 (en) | 2003-05-13 |
JP2014087656A (en) | 2014-05-15 |
CA2383290C (en) | 2013-07-09 |
JP2015084231A (en) | 2015-04-30 |
CA2814259C (en) | 2017-10-17 |
JP5078210B2 (en) | 2012-11-21 |
US20020173875A1 (en) | 2002-11-21 |
JP6046596B2 (en) | 2016-12-21 |
US6735497B2 (en) | 2004-05-11 |
JP5663378B2 (en) | 2015-02-04 |
JP2011172948A (en) | 2011-09-08 |
CA2814259A1 (en) | 2001-03-29 |
AU7609900A (en) | 2001-04-24 |
WO2001021131A2 (en) | 2001-03-29 |
EP1261308A2 (en) | 2002-12-04 |
US20040210341A1 (en) | 2004-10-21 |
JP2003528652A (en) | 2003-09-30 |
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