Abstract:
A medication dispenser provides automation to the steps of locating and acquiring medications to be administered to a patient. The medication dispenser includes an enclosure providing a secure environment for storing medications in multiple sized medication storage bins. The medication storage bins are hung in storage racks located within the enclosure. A robot system is also provided within the enclosure for moving bins between the storage racks and a medication dispensing area. The medication dispensing area includes doors configured to open to define an opening for passing a selected bin through the enclosure. The medication storage bin includes a bulk bin loading drawing for loading medication storage bins into the medication dispensing apparatus.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 12/029,285, filed Feb. 11, 2008 and claims the benefit of U.S. Provisional Application No. 60/889,156, filed Feb. 9, 2007. Each of the aforementioned applications is herein incorporated by reference in its entirety. This application is also related by subject matter to the invention disclosed in the following U.S. patent application filed on even date herewith: U.S. Application No. (not yet assigned) (Attorney Docket Number CRNI.140101), entitled “Medication Dispensing Apparatus for Dispensing Single Items from Multiple-Compartment Bins,” which is assigned or under obligation of assignment to the same entity as this application, and incorporated in this application by reference. 
     
    
     BACKGROUND 
       [0002]    As reported by the Institute of Medicine, an estimated 106,000 deaths occurred in 1994 due to adverse drug reactions (ADRs), and more than 2,000,000 hospitalized patients experienced serious, if not fatal, ADRs. Lazarou J. et al.,  Incidence of adverse drug reactions in hospitalized patients: a meta - analysis of prospective studies , J. Am. Med. Assn. 1998: 279: 1200-1205. Many of these errors are attributable to the systems and methods used to store and deliver medications to those clinicians providing care to patients. Various solutions have been proposed to address the issue of medication delivery errors. For instance, computerized systems ensure that the medication ordered or prescribed by the clinician is clinically appropriate. These systems may verify that the dosage is proper based on patient information such as weight and evidence based guidelines or protocols. Also, these systems may perform interaction checking against other medications. However, even if the clinician orders an acceptable medication and dosage amount for a specific patient, the actual drug and/or dosage administered to the patient may vary from what was requested. A pharmacist or other clinician may accidentally provide an improper drug or drug dosage if the order is not properly communicated and followed at each step in the clinical process. Errors may also occur during the steps of the medication administration process occurring between the pharmacy and the point of care. Existing systems and methods for physically transferring and storing and electronically tracking medications and supplied have been employed include automated dispensing machines (ADMs). To administer a medication to a patient, a nurse or other clinician retrieves the appropriate medication from one of a number of ADMs located throughout the healthcare facility. In addition to failing to prevent medication errors, existing systems and methods employing ADMs are wasteful and oftentimes difficult to use. 
       SUMMARY 
       [0003]    This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. 
         [0004]    Embodiments of the present invention are directed to an automated medication dispenser. The medication dispenser includes an enclosure providing a secure environment for storing medications and/or other medically related items in multiple sized medication-storage bins. The medication storage bins are hung in storage racks located within the enclosure. A robot system is also provided within the enclosure for moving bins between the storage racks and a medication dispensing area. The medication dispensing area includes doors configured to open to define an opening for passing a selected medication-storage bin through the enclosure. In some embodiments, the doors provide a variable-sized opening and, in some instances, the doors are opened to match the size of a bin containing medications selected for dispensing so the bins may be presented to the user in a secure manner. In embodiments, a bulk bin loading drawing is provided for loading medication storage bins into the medication dispensing apparatus. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
         [0005]    In the accompanying drawings, which form a part of the specification and are to be read in conjunction therewith and in which like reference numerals are employed to indicate like parts in the various views: 
           [0006]      FIG. 1  is a perspective view of a medication dispenser in accordance with an embodiment of the present invention; 
           [0007]      FIG. 2  is a front elevational view of a medication dispenser in accordance with an embodiment of the present invention; 
           [0008]      FIG. 3  is a perspective view of a medication dispenser in accordance with an embodiment of the present invention having a door opened showing the interior of the medication dispenser; 
           [0009]      FIG. 4  is a perspective view of a small medication-storage bin in accordance with an embodiment of the present invention; 
           [0010]      FIG. 5  is a perspective view of a medium medication-storage bin in accordance with an embodiment of the present invention; 
           [0011]      FIG. 6  is a perspective view of a large medication-storage bin in accordance with an embodiment of the present invention; 
           [0012]      FIG. 7  is a perspective view showing the bottom of a small medication-storage bin in accordance with an embodiment of the present invention; 
           [0013]      FIG. 8  is a perspective view of a small medication-storage bin having dividers in accordance with an embodiment of the present invention; 
           [0014]      FIG. 9  is a perspective view of a sled for moving medication-storage bins within a medication dispenser in accordance with an embodiment of the present invention; 
           [0015]      FIG. 10  is a fragmentary perspective view showing the interior of medication dispensing areas in a medication dispenser in accordance with an embodiment of the present invention; 
           [0016]      FIG. 11  is a fragmentary perspective view showing the exterior of medication dispensing areas in a medication dispenser in accordance with an embodiment of the present invention; 
           [0017]      FIG. 12  is a fragmentary perspective view showing passage of a small medication-storage bin through a medication dispensing area in a medication dispenser in accordance with an embodiment of the present invention; 
           [0018]      FIG. 13  is a fragmentary perspective view showing passage of a medium medication-storage bin through a medication dispensing area in a medication dispenser in accordance with an embodiment of the present invention; 
           [0019]      FIG. 14  is a fragmentary perspective view showing passage of a large medication-storage bin through a medication dispensing area in a medication dispenser in accordance with an embodiment of the present invention; 
           [0020]      FIGS. 15-17  are perspective views showing a bulk bin cartridge in accordance with an embodiment of the present invention; 
           [0021]      FIGS. 18 and 19  are fragmentary perspective views showing a bulk bin loading drawer in accordance with an embodiment of the present invention; and 
           [0022]      FIG. 20  is a block diagram of an exemplary medication information computing environment suitable for use in implementing the present invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0023]    With reference to the drawings, wherein like reference characters designate like parts throughout the different views, a medication dispenser according to an embodiment of the present invention is designated generally with the reference numeral  10 . The medication dispenser  10  generally includes an enclosure  12  that surrounds other components of the medication dispenser  10 , as depicted in  FIGS. 1-3 . More particularly, the enclosure  12  encases, among other things, a plurality of medication-storage bins  14  disposed in storage racks  16  and a robot system  18  for primarily moving bins  14  between the racks  16  and medication dispensing areas  20  located in the enclosure  12 . The medication dispenser  10  stores and dispenses, for instance, unit or multi-dose medications in syringes, ampules, vials, oral suspensions, tubes, jars, oral solids and other packaging options and a variety of medical supplies. 
         [0024]    The enclosure  12  provides a controlled environment in which medications are stored. In particular, the enclosure  12  regulates access to the medications, such that only those medications that have been dispensed from a medication dispensing area  20  in the enclosure  12  may be removed from the medication dispenser  10 . In some embodiments, a refrigeration unit (not shown) may be coupled with the enclosure  12  to control the temperature and humidity level within the enclosure  12 , which is desirable to avoid spoilage of certain types of medication. 
         [0025]    The enclosure  12  generally includes a front wall  22 , back wall  24 , side walls  26 , top wall  28 , and bottom wall  30 . The front wall  22  includes a door  32  allowing access to the internal components of the medication dispenser  12  (e.g., for loading the medication dispenser with medication and for maintenance purposes and the like). However, the door  32  may be locked to prevent unauthorized access to medications within the enclosure  12 . 
         [0026]    The front wall  22  also generally includes a camera  34 , a printer  36 , medication dispensing areas  20 , a large item dispensing drawer  37 , and bulk bin loading drawers  40 . The camera  34  is provided for security purposes. In particular, the camera  34  may be used to capture still and/or video images of users interacting with the medication dispenser  10 . The printer  36  allows information to be printed, such as, medications dispensed, for instance, for record keeping and to assist clinicians in administering dispensed medications to patients. The large item dispensing drawer  37  allows large medication items to be stored and dispensed when selected by a clinician. For instance, some medications items are too large to be stored in medication-dispensing bins  14  within the enclosure  12  and may be stored and dispensed from the large item dispensing drawer  37 . The large item dispensing drawer  37  is lockable to limit access to only authorized clinicians. A handle  38  is attached to each end of the drawer  37  for moving the drawer  37  between a closed position within the enclosure  12  and an open position allowing access and removal of items. The bulk bin loading drawers  40  facilitate loading medication-storage bins  14  into the medication dispenser (as will be described in further detail below). 
         [0027]    The medication dispenser  10  is configured to store multiple sized bins  14  for medication storage and dispensing. For instance, referring to  FIGS. 4-6 , three different sized bins are provided for storing medications in the medication dispenser  12 . In particular, a small bin  42  is illustrated in  FIG. 4 , a medium bin  44  is illustrated in  FIG. 5 , and a large bin  46  is illustrated in  FIG. 6 . Multiple sized bins facilitate storing different sized medications, as well as different quantities of medications a particular bin, to allow for the efficient use of space within the medication dispenser  10 . Each bin includes four side walls  48  and a base  50  that define a compartment  62  for receiving medications. Additionally, each bin includes a pair of rails  52  positioned on its base  50  to facilitate movement of the bin within the medication dispenser  10  and through the medication dispensing areas  20  (as will be described in further detail below). At least one of the rails  52  includes a series of teeth  54  that may be engaged to facilitate movement of the bin. It should be noted that different bin configurations than those shown in  FIGS. 4-8  may be employed in various embodiments of the invention (e.g., different shape, different number of rails, etc.). 
         [0028]    Each bin may further include one or more identifiers for identifying the bin. For instance, referring to  FIG. 7 , in one embodiment, a magnet  56  and a radio frequency identifier (RFID) tag  58  are positioned on the base  50  of the bin. In an embodiment, the magnet  56  identifies the size of the bin. In particular, a magnet having a particular magnetization may be placed on a bin based on the size of the bin. For instance, larger sized bins may include magnets having larger magnetization. Accordingly, a hall effect sensor may then be used to detect the magnetization of a magnet on a bin and to thereby determine the size of the bin. In other embodiments, the magnets may be located in different positions depending on the size of the bin to increase the ability to detect the bin size. In an embodiment, the RFID tag  58  is used to identify the bin, for instance, for identifying medication stored in the bin and determining a storage location of the bin within the medication dispenser  10 . It should be understood that in some embodiments, other techniques for identifying a bin, such as bar codes, may be employed. 
         [0029]    In some cases, as shown in  FIG. 8 , a bin may also include a number of dividers  60 . The dividers  60  may provide separate sub-compartments  63  in the bin, for instance, for receiving a unit-dose medication in each sub-compartment  63 . By including dividers  60  in bins, in some embodiments, the medication dispenser  10  may provide for unit-based medication dispensing (as will be described in further detail below). 
         [0030]    As shown in  FIG. 3 , medication-storage bins  14  are located in storage racks  16  positioned along the interior side of the back wall  24  and the front wall  22 . The storage racks  16  include a plurality of vertical rack walls  64  separated from one another at a distance dependent on the size of the bins  14  contained in the medication dispenser  10 . A plurality of spring-biased clips  66  are positioned along the vertical rack walls  64  for holding the bins  14  within the storage racks  16 . In operation, a pair of spring-biased clips  66  positioned on opposing vertical rack walls  64  engage side walls of a bin  14  to maintain the bin  14  in the racks  16 . The spring-biased clips  66  releasably engage the bin  14  to allow the bins to be removed from the racks  16 . One skilled in the art will recognize that a variety of other techniques may used for holding the bins  14  within the storage racks  16  within various embodiments of the present invention. Additionally, it should be understood that the configuration of the storage racks  16  shown in  FIG. 3  is for illustrative purposes only. As such, the location and spacing of the vertical rack walls  64  within the enclosure  12  are configurable in various embodiments, for instance, to allow for the storage of different quantities of different sized bins  14 . 
         [0031]    A robot system  18  is provided in the medication dispenser  10  for moving bins  14  within the enclosure  12 . For instance, the robot system  18  may move bins  14  between the storage racks  16  and the medication dispensing areas  20  in the front wall  22 . The robot system  18  generally includes a sled  68  for engaging and loading bins  14  and a system of rails for moving the sled  68  within the enclosure  12  on an x-y-z axis. In particular, the sled  68  slidably engages a vertical rail  70  allowing the sled  68  to move in the y-direction along the vertical rail  70 . The vertical rail  70  has a first end  72  that slidably engages a horizontal rail  74  allowing the vertical rail  70  (and sled  68 ) to move in the z-direction along the horizontal rail  74 . The horizontal rail  74 , in turn, slidably engages a fixed horizontal rail  76  allowing the horizontal rail  74  (as well as the vertical rail  70  and sled  68 ) to move in the x-direction along the fixed horizontal rail  76 . Each of the rails  70 ,  74 ,  76  may include a flat bar, round post, or other form and may be constructed of metal or other suitable material. Additionally, although only a single rail is shown for each of the rails  70 ,  74 ,  76 , multiple rails may be employed for each in various embodiments of the invention. Additionally, it should be noted that the robot system  18  described herein is provided for illustrative purposes only and should not be viewed as limiting as other techniques and mechanisms for moving bins  14  within the enclosure  12  may be employed. 
         [0032]    As shown in  FIG. 9 , the sled  68  generally comprises a platform  78  with raised edges  80  and includes a dual belt system  82  positioned on the platform  78  for engaging a bin  14  and pulling the bin  14  onto the sled  68 . The dual belt system  78  generally includes a pair of toothed belts  84  looped around a series of pulleys  88 . The teeth  86  of each toothed belt  84  may engage the teeth  54  located on the rails  52  on the base of a bin  14  (of  FIG. 7 ) to facilitate movement of the bin  14  across the sled  68 . A powered gear  90  is also provided for each toothed belt  84  to engage and rotate the toothed belt  84  around the pulleys  88 . The rotation of the gears  90  is reversible allowing the dual belt system  82  to move a bin  14  across the sled  68  in both directions. For instance, the toothed belts  84  may be rotated in one direction to retrieve a bin  14  from the storage racks  16  along the back wall  24  and may be rotated in the opposite direction to return a bin  14  to the storage racks  16  along the back wall  24  of  FIG. 3 . 
         [0033]    As shown in the illustrated embodiment of  FIG. 9 , the sled  68  includes an RFID reader  92  on each end of the platform  78 . The RFID reader  92  allows the sled  68  to identify a bin  14  by reading an RFID tag located on the bin  14 . An RFID reader  92  is located on each end of the platform  78  to allow an RFID tag to be read on a bin  14  located in racks on either the front wall  22  or the back wall  24  without requiring the sled  68  to engage the bin  14 . One skilled in the art will recognize that other techniques, such as bar codes and bar code scanners, may be employed for allowing the sled  68  to identify bins  14  within the medication dispenser  10 . 
         [0034]    The sled  68  also includes a hall effect sensor  94  on each end of the platform  78 , and positional magnets (not shown) are located within the interior of the enclosure  12  for calibrating the robot system  18  to the storage rack configuration. In particular, a positional magnet having a particular magnetization is provided at a home location for the sled  68 . To calibrate the robot system  18 , the sled  68  is moved to the home location and is then moved through the enclosure to locate the positional magnets and map the configuration. Accordingly, the calibration process allows the robot system  18  to correctly position the sled  68  to engage bins properly during operation, as well as correctly align the sled  68  with the medication dispensing areas  20 . 
         [0035]    With reference now to  FIGS. 10 and 11 , the medication dispensing areas  20  provided in the front wall  22  of the enclosure  12  are further illustrated. The medication dispensing areas  20  allow for the passage of bins  14  through the enclosure  12 , primarily for dispensing medications from the medication dispenser  10  but also for loading medications into the medication dispenser  10 . Each of the medication dispensing areas  20  generally includes a pair of doors  96  and a dual belt system  98  that is positioned in a recessed area  100  within a medication dispensing shelf  102  formed in the front wall  22 . Each dual belt system  98  facilitates movement of bins  14  through the pair of doors  96  and is similar to the dual belt system  82  located on the sled  68  described hereinabove. 
         [0036]    A reversible motor  104  is provided for operating each of the doors  96 . The output of each reversible motor  104  is coupled to a gear  106  that engages a toothed track  108  located along a respective door  96  to actuate the movement of the door  96  up and down. Although not required, in some embodiments, the doors  96  are configured to open to provide a variable-sized opening. In an embodiment, the pair of doors  96  for a medication dispensing area  20  are configured to open to match the size of the bin  14  being passed through the medication dispensing area  20  to prevent access to the interior of the enclosure  12 . For instance, referring to  FIG. 12 , the width of a single door  96  matches the width of the small bin, but the height of the door  96  exceeds the height of the small bin. Accordingly, when the small bin is passed through the medication dispensing area  20 , a single door  96  is opened to the height of the small bin. 
         [0037]    As shown in  FIG. 13 , the width of the pair of doors  96  matches the width of the medium bin, but the height of the door  96  exceeds the height of the medium bin. As such, when the medium bin is passed through the medication dispensing area  20 , the pair of doors  96  are opened to the height of the medium bin. Referring now to  FIG. 14 , the width of the pair of doors  96  matches the width of the large bin, and the height of the pair of doors  96  matches the height of the large bin. Accordingly, when the large bin is passed through the medication dispensing area  20 , the pair of doors  96  are opened fully. As can be seen in each of  FIGS. 12-14 , access to the interior of the enclosure  12  is minimized by opening the doors  96  to match the size of the bin being passed through a medication dispensing area  20 . 
         [0038]    In the illustrated embodiment shown in  FIGS. 10 and 11 , hall effect sensors  110  are located on the medication dispensing shelf  102  to identify the size of a bin  14  being presented to a medication dispensing area  20 . In particular, hall effect sensors  110  are located adjacent the dual belt system  98  for each medication dispensing area  20  on both the interior and exterior sides of the doors  96 . When a bin  14  is presented to a medication dispensing area  20 , a hall effect sensor  110  detects the magnetization of a magnet located on the bin  14  to determine the size of the bin  14 . The doors  96  are then operated based on the determined bin size. 
         [0039]    It should be understood that other techniques for identifying the size of a bin for operating the doors  96  of a medication dispensing area  20  may be employed within embodiments of the present invention. For instance, RFID readers or bar code readers may be located adjacent the dual belt systems  98  in place of the hall effect sensors. The RFID reader or bar code reader may then be employed to determine the size of a bin  14  by detecting an RFID tag or bar code on the bin  14 . In another embodiment, a computer system may store information for each bin  14 , including the size of the bin  14 , and bin size information may be retrieved when a bin  14  is selected to be passed through a medication dispensing area  20 . Any and all such variations are contemplated to be within the scope of embodiments of the present invention. 
         [0040]    Referring again to  FIG. 3 , to stock the medication dispenser  10 , medications are initially placed into bins  14  and the bins  14  are then hung in the storage racks  16 . When medications are placed into each bin  14 , the medications and bins  14  are identified to a computer system, which associates the medications with their corresponding bins  14 . For instance, a bin  14  may be identified to the computer system by reading an RFID tag or bar code located on the bin  14  or by manually entering a bin identifier. Similarly, in some embodiments, each medication may be provided in a package having an identification marking, such as a bar code, an RFID tag, or some other identifier. A medication may then be identified to the computer system by reading the bar code or RFID tag located on the medication package or by manually entering an identifier associated with the medication. 
         [0041]    After medications have been placed into bins  14  and the medications and bins  14  have been associated by the computer system, the bins  14  may be loaded into the medication dispenser  10  in a number of different ways in accordance with various embodiments of the invention. In one embodiment, the medication dispenser  10  is stocked by opening the door  32  and manually placing bins  14  in the storage racks  16 . Typically, the medication dispenser  10  is loaded in this manner at the outset of stocking the medication dispenser  10  with medications. When the bins  14  are manually loaded into the medication dispenser  10  in this manner, the location at which each of the bins  14  is placed in the storage racks  16  is provided to the computer system to allow the bins  14  to be subsequently located, for instance, for medication dispensing. 
         [0042]    In one embodiment, the location of each bin  14  may be manually entered into the computer system. In another embodiment, the location of each bin  14  may be automatically determined. For instance, the sled  68  may be moved through the medication dispenser  10  to identify the location of each bin  14  by reading the RFID tag or other identifier on the bin  14  and to provide the location of the bin  14  to the computer system such that the identifier for the bin  14  and its location may be associated in the computer system. 
         [0043]    Typically, after initialing stocking the medication dispenser  10  with medications, further stocking can be accomplished without opening the door  32  in the medication dispenser  12 , thereby limiting access to the medications stored therein. In particular, medications may be loaded into the medication dispenser  10  by either loading bins  14  through one of the medication dispensing areas  20  or by using a bulk bin loading drawer  40 . 
         [0044]    With reference to  FIGS. 10 and 11 , loading medications using the medication dispensing areas  20  will first be described. Initially, medications are associated with a bin  14  as described hereinabove by identifying the bin  14  and the medications to the computer system. The medications are then placed in the bin  14  and the bin  14  is introduced to one of the medication dispensing areas  20 . The bin  14  is placed on the medication dispensing shelf  102 , and the bin size is identified by a hall effect sensor  110  to determine the opening of the doors  96  required to match the size of the bin  14  to thereby limit access to medications in the medication dispenser  10 . As indicated previously, in some embodiments, the bin size may be determined by other techniques (e.g., by identifying the bin by reading an RFID tag or bar code or by manually entering an identifier for the bin and looking up a stored bin size). The doors  96  are opened to match the determined bin size and the dual belt system  98  is activated to move the bin  14  across the medication dispensing shelf  102  into the medication dispenser  10 . The bin  14  is then moved onto the sled  68 , which places the bin  14  into the storage racks  16 . In one embodiment, a location for the bin  14  may be manually selected when the bin  14  is introduced to the medication dispensing area  20 , such that the sled  68  places the bin  14  at that location. For instance, a user may interact with an input device associated with the medication dispenser  10  to select a particular rack location for the bin  14 . In another embodiment, a location for the bin  14  may be automatically selected. For instance, the computer system may select a location for the bin  14  and operate the robot system  18  to place the bin  14  at that location. In any case, the computer system stores the location of the bin  14  in the storage racks  16  in association with a bin identifier. 
         [0045]    Bins  14  may also be loaded into the medication dispenser  10  in bulk without opening the door  32  by using the bulk bin loading drawers  40  and a bulk bin cartridge  112  as shown in  FIGS. 15-19 , thereby speeding the loading process for multiple bins  14  as compared to loading bins through the medication dispensing areas  20 . Initially, bins  14  are loaded with medications as described hereinabove by identifying the bins  14  and the medications to the computer system and placing the medications into the bins  14 . The bins  14  are then loaded into a bulk bin cartridge  112  such as that shown in  FIGS. 15-17 . The bulk bin cartridge  112  generally includes a front wall  114 , a top wall  116 , a bottom wall  118 , a pair of side walls  120 , and a number of interior walls  122  to form compartments  124  for receiving bins  14 . The bulk bin cartridge  112  also includes a hinged wall  126  that is hingedly attached to the top wall  116 , thereby allowing the hinged wall  126  to be moved from an open position as shown in  FIG. 16  (e.g., to allow bins  14  to be put into or removed from the bulk bin cartridge  112 ) and a closed position as shown in  FIG. 17  (e.g., to maintain bins  14  in the compartments  124  when moving the bulk bin cartridge  112 ). It should be noted that in various embodiments, the hinged wall may be attached in different manners. Additionally, a pair of handles  128  are positioned on the front wall  114  to facilitate carrying the bulk bin cartridge  112 . 
         [0046]    After being loaded with bins  14 , the bulk bin cartridge  112  is transported to the medication dispenser  10  for loading the bins  14  into the medication dispenser  10 . Each bulk bin loading drawer  40  in the medication dispenser  10  includes a hinged door  126  and a chamber  132  configured for receiving a bulk bin cartridge  112 . As shown in  FIGS. 18 and 19 , to load the bulk bin cartridge  112  into the bulk bin loading drawer  40 , the hinged wall  126  on the bulk bin cartridge  112  is moved to the open position to expose the bins  14  in the compartments  124 . Additionally, the hinged door  126  for the bulk bin loading drawer  40  is opened, and the bulk bin cartridge  112  is slid into the chamber  132  of the bulk bin loading drawer  40 . The robot system  18  is then operated to pick each bin  14  from the bulk bin cartridge  112  and place each bin at a location in the storage racks  16 . As indicated above, the location for each bin  14  may be manually or automatically selected, and location information may be stored by the computer system in association with a bin identifier for subsequently locating each bin  14 . 
         [0047]    Referring again to  FIG. 3 , some embodiments of the invention employ medication zoning to facilitate the speed of medication dispensing. In particular, bins  14  may be located within the medication dispenser  10  based on the frequency of use of medications contained in each bin. For instance, bins  14  containing medications that are more frequently used may be positioned in the storage racks  16  at locations that reduce the amount of time required to retrieve the bins  14  and move the bins  14  to the medications dispensing area (e.g., the storage racks  16  along the front wall  22  closest to the medication dispensing areas  20 ). 
         [0048]    Empty bins or bins containing stale medications may be removed from the medications dispenser  10  in a manner similar to those discussed for loading the medication dispenser. For instance, bins may be removed by opening the door  32  in the enclosure  12 , by employing the medication dispensing areas  20 , or by using the bulk bin loading drawers. 
         [0049]    When a medication is to be dispensed from the medication dispenser  10 , a medication is initially selected, for instance, by a clinician interacting with a computer system associated with the medication dispenser  20 . The computer system accesses information associating medications with bins to identify the bin  14  containing the selected medication. Additionally, the computer system determines the location of the bin  14  within the storage racks  16  of the medication dispenser  10 . The robot system  18  then moves the sled  68  to the identified location of the bin  14  and engages the bin  14  to move the bin  14  onto the sled  68 . After the robot system  18  moves the sled  68  to one of the medication dispensing areas  20 , the dual belt system  82  on the sled  68  is operated to move the bin  14  from the sled  68  to the dual belt system  98  of the medication dispensing area  20 . The bin size is determined (e.g., by the hall effect sensor  110  or by referring to stored bin size information for the retrieved bin), and the doors  96  are opened to matched the size of the bin  14 . The dual belt system  98  then moves the bin  14  across the medication dispensing shelf  102  through the opened doors  96 . In some embodiments, the doors  96  remain opened after the bin  14  has been moved to the exterior of the enclosure  12 , and a locking mechanism (not shown) is provided to maintain the bin  14  in position on the medication dispensing shelf  102  to prevent access through the opening. In other embodiments, the doors  96  are closed after the bin  14  has been moved to the exterior of the enclosure  12 , and the bin  14  may be removed from the medication dispensing shelf  102 . 
         [0050]    To return the bin  14  to the storage racks  16  in the medication dispenser  10 , a bin return button  134  is provided on the medication dispensing shelf  102 . When the bin return button  134  is pressed, the dual belt system  98  moves the bin  14  across the medication dispensing shelf  102  to the interior of the enclosure  12  and the doors  96  are closed. In embodiments, two bin return buttons may be located on the medication dispenser  10 , and the bin return buttons must be pressed substantially simultaneously to move the bin  14  into the enclosure  12 . The robot system  18  then moves the bin  14  from the medication dispensing area  20  back to the storage racks  16 . Typically, the bin  14  is placed at the location in the storage racks  16  from which it was previously removed. However, the bin  14  could be placed at a new location in the storage racks  16 , which is then stored by the computer system. 
         [0051]    The medication dispenser  10  is provided with two medication dispensing areas  20  in the illustrated embodiment to facilitate speed of medication dispensing. In particular, in some cases, a clinician may select multiple medications for dispensing. In such cases, the robot system  18  retrieves a first bin containing a first selected medication and presents the first bin to the first medication dispensing area  20 . While the first bin is moved through the medication dispensing area  20 , the robot system  18  retrieves a second bin containing a second selected medication and presents the second bin to the other medication dispensing area  20 . After the clinician retrieves the first medication from the first bin, the clinician pushes the bin return button  134 , causing the first bin to be returned to the interior of the enclosure  12  and the second bin to be moved to the exterior of the enclosure. The robot system  18  returns the first bin to the storage racks  16  and retrieves a bin containing the next selected medication for delivery to the medication dispensing area  20 . The process is continued until all selected medications have been dispensed. 
         [0052]    In some embodiments, the medication dispenser  10  may be configured to provide unit-dose medication dispensing by employing bins  14  with dividers  60  such as the bin shown in  FIG. 8 . In operation, a unit-dose medication is placed within each of a number of sub-compartments  63  of the bin. When a unit-dose medication is to be dispensed from the bin, the bin is retrieved from the storage racks  16  and presented to a medication dispensing area  20  as described above. The doors  96  are opened based on the size of the bin, and the dual belt system  98  in the medication dispensing area  20  is operated to move the bin such that only a first sub-compartment  63  is exposed on the exterior of the enclosure  12 . As such, only the unit-dose medication in the first sub-compartment  63  may be withdrawn. As medications are dispensed, the computer system tracks how many unit-dose medications have been dispensed from a particular bin. Accordingly, the next time the same medication is selected to be dispensed, the computer system recognizes that a unit-dose medication has been withdrawn from the first sub-compartment  63  in the bin. After the bin has been retrieved and presented to the medication dispensing area  20 , the doors  96  are opened and the dual belt system  98  is operated to move the bin such that the first and second sub-compartments  63  are exposed on the exterior of the enclosure  12 . Unit-dose medication dispensing continues in this manner by successively exposing the sub-compartment with the next available unit-dose medication until all unit-dose medications have been withdrawn from the bin. 
         [0053]    As indicated previously, a computer system is provided for controlling the operation of the medication dispenser  10 . In some embodiments, the computer system includes a computing device dedicated to the medication dispenser  10 . The medication dispenser computing device may receive inputs, such as inputs associated with bin-loading and medication-dispensing operations. Based on the inputs, the medication dispenser computing device controls the robot system  18  to move bins  14  within the enclosure. Additionally, the medication dispenser computing device controls the operation of the doors  96  and dual belt system  98  for each medication dispensing area  20  based on the inputs. 
         [0054]    In some embodiments, the medication dispenser computing device may act as a stand-alone device such that the medication dispenser computing device maintains all data necessary for operating the bin-loading and medication dispensing operations of the medication dispenser  10 . In other embodiments, however, the medication dispenser computing device operates within a distributed clinical computing environment. In particular, the medication dispenser computing device may be interfaced with or integrated into a medical information computer system. The medical information computing system may be a comprehensive computing system within a clinical environment such as the exemplary medical information computing system environment  200  shown in  FIG. 20 . It will be understood and appreciated by those of ordinary skill in the art that the illustrated medical information computing system environment  200  is merely an example of one suitable computing environment and is not intended to suggest any limitation as to the scope of use or functionality of the invention. Neither should the medical information computing system environment  202  be interpreted as having any dependency or requirement relating to any single component or combination of components illustrated therein. 
         [0055]    Embodiments of the present invention may be operational with numerous other general purpose or special purpose computing system environments or configurations. Examples of well-known computing systems, environments, and/or configurations that may be suitable for use with the present invention include, by way of example only, personal computers, server computers, hand-held or laptop devices, multiprocessor systems, microprocessor-based systems, set top boxes, programmable consumer electronics, network PCs, minicomputers, mainframe computers, distributed computing environments that include any of the above-mentioned systems or devices, and the like. 
         [0056]    Embodiments of the present invention may be described in the general context of computer-executable instructions, such as program modules, being executed by a computer. Generally, program modules include, but are not limited to, routines, programs, objects, components, and data structures that perform particular tasks or implement particular abstract data types. Embodiments of the present invention may also be practiced in distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules may be located in local and/or remote computer storage media including, by way of example only, memory storage devices. 
         [0057]    With continued reference to  FIG. 20 , the exemplary medical information computing system environment  200  includes a general purpose computing device in the form of a server  202 . Components of the server  202  may include, without limitation, a processing unit, internal system memory, and a suitable system bus for coupling various system components, including database cluster  204 , with the server  202 . The system bus may be any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, and a local bus, using any of a variety of bus architectures. By way of example, and not limitation, such architectures include Industry Standard Architecture (ISA) bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus, Video Electronic Standards Association (VESA) local bus, and Peripheral Component Interconnect (PCI) bus, also known as Mezzanine bus. 
         [0058]    The server  202  typically includes, or has access to, a variety of computer readable media, for instance, database cluster  204 . Computer readable media can be any available media that may be accessed by server  202 , and includes volatile and nonvolatile media, as well as removable and non-removable media. By way of example, and not limitation, computer readable media may include computer storage media and communication media. Computer storage media may include, without limitation, volatile and nonvolatile media, as well as removable and nonremovable media implemented in any method or technology for storage of information, such as computer readable instructions, data structures, program modules, or other data. In this regard, computer storage media may include, but is not limited to, RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, digital versatile disks (DVDs) or other optical disk storage, magnetic cassettes, magnetic tape, magnetic disk storage, or other magnetic storage device, or any other medium which can be used to store the desired information and which may be accessed by the server  202 . Communication media typically embodies computer readable instructions, data structures, program modules, or other data in a modulated data signal, such as a carrier wave or other transport mechanism, and may include any information delivery media. As used herein, the term “modulated data signal” refers to a signal that has one or more of its attributes set or changed in such a manner as to encode information in the signal. By way of example, and not limitation, communication media includes wired media such as a wired network or direct-wired connection, and wireless media such as acoustic, RF, infrared, and other wireless media. Combinations of any of the above also may be included within the scope of computer readable media. 
         [0059]    The computer storage media discussed above and illustrated in  FIG. 1 , including database cluster  204 , provide storage of computer readable instructions, data structures, program modules, and other data for the server  202 . 
         [0060]    The server  202  may operate in a computer network  206  using logical connections to one or more remote computers  208 . Remote computers  208  may be located at a variety of locations in a medical or research environment, for example, but not limited to, clinical laboratories, hospitals and other inpatient settings, veterinary environments, ambulatory settings, medical billing and financial offices, hospital administration settings, home health care environments, and clinicians&#39; offices. Clinicians may include, but are not limited to, a treating physician or physicians, specialists such as surgeons, radiologists, cardiologists, and oncologists, emergency medical technicians, physicians&#39; assistants, nurse practitioners, nurses, nurses&#39; aides, pharmacists, dieticians, microbiologists, laboratory experts, genetic counselors, researchers, veterinarians, students, and the like. The remote computers  208  may also be physically located in non-traditional medical care environments so that the entire health care community may be capable of integration on the network. The remote computers  208  may be personal computers, servers, routers, network PCs, peer devices, other common network nodes, or the like, and may include some or all of the components described above in relation to the server  202 . The devices can be personal digital assistants or other like devices. 
         [0061]    Exemplary computer networks  206  may include, without limitation, local area networks (LANs) and/or wide area networks (WANs). Such networking environments are commonplace in offices, enterprise-wide computer networks, intranets, and the Internet. When utilized in a WAN networking environment, the server  202  may include a modem or other means for establishing communications over the WAN, such as the Internet. In a networked environment, program modules or portions thereof may be stored in the server  202 , in the database cluster  24 , or on any of the remote computers  208 . For example, and not by way of limitation, various application programs may reside on the memory associated with any one or more of the remote computers  208 . It will be appreciated by those of ordinary skill in the art that the network connections shown are exemplary and other means of establishing a communications link between the computers (e.g., server  202  and remote computers  208 ) may be utilized. 
         [0062]    In operation, a user may enter commands and information into the server  202  or convey the commands and information to the server  202  via one or more of the remote computers  208  through input devices, such as a keyboard, a pointing device (commonly referred to as a mouse), a trackball, or a touch pad. Other input devices may include, without limitation, microphones, satellite dishes, scanners, or the like. Commands and information may also be sent directly from a remote healthcare device to the server  202 . In addition to a monitor, the server  202  and/or remote computers  208  may include other peripheral output devices, such as speakers and a printer. 
         [0063]    Although many other internal components of the server  202  and the remote computers  208  are not shown, those of ordinary skill in the art will appreciate that such components and their interconnections are well known. Accordingly, additional details concerning the internal construction of the server  202  and the remote computers  208  are not further disclosed herein. 
         [0064]    By interfacing and/or integrating a medication dispensing computing device with a comprehensive medical information computing system, such as the medical information computing system  200  of  FIG. 20 , a number of advantages may be realized. For example, the medication dispensing clinical device may be interfaced with or otherwise access computing devices and/or computing systems in a variety of different clinical domains within a healthcare environment. By way of example only and not limitation, the medical information computing system  200  may include a clinical laboratory system, a pharmacy system, a radiology system, and a hospital administration system. Accordingly, the medical information computing system  200  provides a unified computing architecture that is able to access and aggregate clinical information from a variety of different clinical domains and make the clinical information available to the medication dispensing computing device. In an embodiment, the medical information computing system  200  may store clinical information from different clinical domains in a patient-centric electronic medical record (including an electronic medication administration record) accessible to multiple devices within the system  200 , including the medication dispensing computing device. Accordingly, medication dispensing may be automated and clinician workflow may be supported from medication prescribing through medication dispensing and administration. As such, a closed process may be provided that delivers increased patient safety throughout the medication process, greater speed in the medication dispensing process, and improved efficiency for clinicians. 
         [0065]    The present invention has been described in relation to particular embodiments, which are intended in all respects to be illustrative rather than restrictive. Alternative embodiments will become apparent to those of ordinary skill in the art to which the present invention pertains without departing from its scope. Substitutions may be made and equivalents employed herein without departing from the scope of the invention as recited in the claims. It will be understood that certain features and subcombinations are of utility and may be employed without reference to other features and subcombinations. This is contemplated and within the scope of the claims.