Shortly after being named Ontario's Minister of Health and Long-term Care last summer, David Caplan was getting a routine eye exam at Toronto's Sunnybrook hospital when his wife, who works there as a nurse, asked him to look at a new drug-dispensing device.
"After my appointment, my wife said, 'You've got to come check this out,' and she showed me the machine that was in place," he said. "I thought it was a fantastic idea - it's new technology that a variety of companies could develop and support and it's a really innovative way of improving patient care."
In a matter of minutes, Mr. Caplan's wife, Leigh, had accomplished what years of lobbying the Ontario government couldn't.
The machine that Mr. Caplan is referring to is the brainchild of an Oakville, Ont.-based startup called PCA Services Inc.
While its executives bristle at this description, their innovation, which they call PharmaTrust, is akin to a high-tech vending machine (more closely resembling an ABM) for pharmaceutical drugs.
A version of the system is being tested at Sunnybrook Health Sciences Centre as well as a medical clinic in Toronto. PCA's executives, a highly motivated team paid only in shares of the still unprofitable company, had spent a considerable amount of energy in the prior years trying to persuade the Ontario government of the merits of their machine, which they argue could help with issues such as a shortage of pharmacists and rising drug costs.
When Mr. Caplan saw the system in action, he began to come onside. Patients benefit from the convenience and enhanced safety, and a more efficient dispensing system translates into cost savings, he says.
Not everyone's convinced. The idea has faced fierce opposition from certain pharmacists and drug stores, with some contingents lobbying hard to block its path.
But last month, Ontario introduced legislation that, among other things, will amend the Drug and Pharmacies Regulation Act and the Ontario Drug Benefit Act to allow for the remote dispensing of drugs in the province. That means prescription drugs could be dispensed under the supervision of a licensed pharmacist, without that pharmacist having to be physically present at the dispensing location.
The bill has gone through second reading and could receive royal assent later this year, making it law.
Until then, all pharmacies must be under the supervision of a pharmacist who is physically on the premises, and so the test at Sunnybrook is taking place under the supervision of the hospital's pharmacy.
"It's important to note that, while some have suggested the machines would replace pharmacists, this is actually quite untrue," Mr. Caplan says. "The pharmacist would perform the same services he or she currently provides, but through a virtual medium with the use of technology. Also, some pharmacists may choose to include such machines in their own premises so they can offer another service option for their clients."
PCA hopes to have the third version of the system ready this fall, and the company expects it will be able to hold nearly 1,500 different items, from puffers to pill bottles and tubes.
To use it, customers insert the prescription, pick up a telephone handset on the machine, and speak to a pharmacist via a two-way video-conferencing system. They can pay for their medication using cash, credit, debit or their drug card.
When the pharmacist is ready to dispense the drug, the machine identifies it using both RFID (radio-frequency identification) and a bar-code label that is read by a camera. As a final check that the machine is dispensing the correct product, it weighs the drug before spitting it out.
If the machine is not holding the drug that's been prescribed, the company offers to deliver it to the patient's home the next day.
With PCA Services planning to focus on Ontario as its core market for now, convincing the provincial government of the machine's value was a key hurdle.
It's one of many the company has overcome, but plenty remain in its way.
Canada's underwhelming venture capital market was a major stumbling block, says Peter Suma, co-founder and chief operating officer of PCA Services.
"In the U.S., this project would have had four times the amount of money put into it," he says.
The company has raised more than $12-million from so-called angel investors to fund its startup operations. It says it doesn't foresee turning a profit until the second half of 2010 at the earliest.
Designing the machine has probably been the largest challenge. There, too, a lucky break supplanted years of work.
For more than two years, PCA had been hiring engineers and other experts in an attempt to find a better way for the machine to physically pick up the drug once it's selected. Despite all the hoopla, robotic technology has not reached the stage that many people might expect, Mr. Suma says.
The team was talking about the problem one day when Todd Willick, a 22-year-old Waterloo University graduate who first joined the company as an intern, had a eureka moment.
"His inspiration was a fish hook," Mr. Suma says. "Young brains think differently."
Mr. Suma immediately called a patent agent, and Mr. Willick is receiving shares in the company.
One major hurdle yet to be leaped is the need to convince the public of the technology's usefulness, and teach people how to use it.
"Most people do not know what it is," Mr. Suma says. "Your average patient walks by and thinks it's a bank machine or something."
Executives liken it to the dawn of ABMs, noting that the first bank machine was installed in London in the late 1960s and it took more than three decades before 1 million machines were deployed. Then the growth rate took off.
The public won't be able to test the PharmaTrust system until the company manages to have it widely deployed, and that too will not be easy. PCA Services is in talks with a major retailer and other potential customers right now, but executives acknowledge it's tough slogging.
"We think it's the future, but it's going to take some time to get there," Mr. Suma says.
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