Now, a pharmacist at a computer workstation across town or across the state can dispense medicines from remote-controlled pharmaceutical dispensing machines, bringing pharmacy services to clinics and communities too small or too remote to support a conventional pharmacy.

Telepharmacy systems allow pharmacists to receive prescriptions via modem or fax, review the Rx and the patient medical record, and electronically signal the dispensing machine at another location to deliver the medication. Then, presto, like a package of cookies, out drops a packet of antibiotics or anti-inflammatories. A nurse or technician retrieves the packet and, using a bar-code scanner, verifies the medication is correct before handing it to the patient.

The U.S. Army, facing a shortage of military pharmacists, is testing the technology at Fort Gordon, Ga., at the Eisenhower Medical Facility. This facility, which provides extended-hour care to military personnel and dependents, is now equipped with two dispensing cabinets, called Automated Drug Dispensing Systems (or ADDS), from Telepharmacy Solutions (formerly ADDS Inc.), North Billerica, Mass. Each cabinet is about the size of a refrigerator and stores an assortment of prepackaged liquids, creams, inhalers, and 60 different medications in packets of nine or 18. Eventually, the military believes, telepharmacy technology could supply pharmaceutical solutions to soldiers deployed in remote regions, such as Bosnia.

With ADDS, the medication is cached in the machines like snack food stocked in vending machines, except these high-grade steel cabinets are locked and password-protected to meet security standards set by the Drug Enforcement Administration.

The Fort Gordon system, installed last July, dispenses between 20 and 30 prescriptions each night, according to Army Lt. Col. Donald Goode, assistant chief of pharmacy. While the final report is pending, the Fort Gordon pharmacists are already satisfied with ADDS. "The methodology and procedures are good, plus it meets JCAHO [Joint Commission on Accreditation of Healthcare Organizations] requirements," Goode said.

An ADDS computer workstation controls the cabinets, not only managing the drug inventory but also interfacing with the patient's electronic medical record (EMR), a feature important to the Department of Defense (DOD) to ensure adherence to strict pharmaceutical standards. In the past, a dubious paper trail left in the patient's medical file was the only way DOD had of complying with these standards. The ADDS technology, with its capacity to interface with the DOD's new EMR (called the Composite Health-Care System) automatically adds the prescription to the patient's file.

Telepharmacy technology, which potentially allows a pharmacist to dispense drugs anywhere there's a phone line, has attracted the interest not only of the DOD (which has installed another ADDS demonstration at Langley Air Force Base in Virginia) but also of the Department of Veterans Affairs, which has several of the cabinets deployed in its outlying or after-hours clinics. The Immigration & Naturalization Service is also testing ADDS at one of its medical facilities in Arizona.

So far, Telepharmacy Solutions has rolled out about 75 ADDS systems, which can be either purchased for about $60,000 or leased for approximately $1,700 a month. As an alternative for those in the private sector with limited capital to invest, the company offers a profit-sharing arrangement whereby it provides ADDS free, then shares the profits.

These telepharmacy systems are also finding homes in villages like Rockford, a rural town in Iowa that's too small to support a traditional pharmacy. There, a pharmacist 30 miles away in Sheffield dispenses drugs at the Rockford medical clinic via a telephone link connecting a computer at the pharmacy to the clinic's ADDS telepharmacy system. The remote pharmacist controls the ADDS device, performing prescription reviews and dispensing drugs, which a nurse at the clinic then bar-code checks for accuracy before presenting to the patient.

The principal payoff is in patient convenience (no one wants a 60-mile, round-trip drive to fill an Rx, especially when sick), but lower drug costs are also likely. Because generic drugs are used in the cabinets, the average prescription price in Rockford is $19.93, compared with $30 at the Sheffield pharmacy.

While the technology is used primarily by rural hospitals or clinics and small, remote military dispensaries, experts believe that in the future ADDS may appear in underserved urban areas, homeless shelters, nursing homes, and prisons. One day, we may even see them in airports, malls, and hotels.