Patent Publication Number: US-7596426-B2

Title: Method of monitoring medical item inventory

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of U.S. application Ser. No. 09/014,076 filed on Jan. 27, 1998, which is a divisional of U.S. application Ser. No. 08/361,783 filed on Dec. 16, 1994, and the disclosures of each of these applications are incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     This invention relates to inventory monitoring and dispensing devices and systems. Particularly this invention relates to apparatus for dispensing and tracking an inventory of medical items used to treat patients in a hospital, clinic or other healthcare setting. 
     BACKGROUND ART 
     The treatment of patients in hospitals and clinics usually involves the receipt by the patient of medical items. These items may include consumable items such as medications. Medical treatment may also involve other disposable items such as dressings and bandages or other medical equipment. Items implanted into the patient or used in conjunction with surgical procedures may also be used and consumed during the course of a patient&#39;s medical treatment. Examples of such items include splints, catheters or guide wires which are normally used during cardiac catheterization or angioplasty. To serve the needs of its patients, a clinic or hospital must always maintain sufficient stocks of these items on hand. Further, as medical items are often expensive, the charges associated with their use must be accurately billed to the patient. 
     Currently most systems for tracking inventory and use of medical equipment items in a hospital or clinic environment are manual systems. The persons responsible for maintaining an inventory of particular items must monitor the use of the items in each storage location within the hospital and order additional supplies when it is noted that the available stocks are running low. Often personnel are only familiar with the stocks available in a particular storage location and as a result, additional stocks may be ordered even though ample supplies are available elsewhere in the same facility. 
     Certain drugs used in the course of medical treatment are regulated narcotics. Supplies of such drugs must be kept in secure cabinets. Items may be dispensed from the secure cabinets only by two (2) authorized users accessing the material and certifying the manner in which it is used. The use of such narcotics also may require considerable paperwork which takes away valuable time that could be used for treating patients. 
     The recording of medical items so that the patient may be billed for their use in the course of treatment is also largely a manual operation. The fact of use by the patient must be recorded in the patient&#39;s chart for later billing. In some cases items have peel-off labels that include a bar code that can be scanned and used for billing purposes. However, this still requires that the nurse or medical technician transfer the correct coding to the proper location for later billing. 
     Complications in billing become even greater when items are removed from inventory to accomplish a planned surgical procedure and then the items are not used. A patient may be charged for use of a particular item which is removed from inventory in anticipation of surgery. If during the surgery the item is not needed, a corresponding credit must be issued when the item is returned to stock. All of these activities take time away from persons who could otherwise devote their time to the treatment of patients. Such tracking and billing practices are also prone to inaccuracies which may cause the hospital or clinic to lose money or which may result in over billing of the patient. 
     Thus there exists a need for an apparatus and system for monitoring and dispensing medical items in hospital or clinic environments that can more accurately monitor inventories, dispense medical items and correlate the use of medical items with the patient whose treatment has included their use. 
     DISCLOSURE OF INVENTION 
     It is an object of the present invention to provide a system for monitoring an inventory of medical use items to provide an indication of what items have been used. 
     It is a further object of the present invention to provide a system for monitoring the use of medical use items so that supplies may be replenished before depletion. 
     It is a further object of the present invention to provide a system for monitoring an inventory of medical use items that monitors a plurality of items in real time. 
     It is a further object of the present invention to provide a system for monitoring an inventory of medical use items that requires the processing of no paper forms. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that indicates the patient whose treatment has involved the medical use items. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that can be used to indicate the technician or physician who has used such medical use items. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that provides for crediting of a patient&#39;s account upon return of an unused item to inventory. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that is used to store and dispense restricted items in a secure manner. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that can guide a user to select the items that will be used in a particular medical procedure. 
     It is a further object of the present invention to provide a system for monitoring and dispensing medical use items that may be used to track and dispense a wide variety of various items and to record their use in a clinical or hospital environment. 
     Further objects of the present invention will be made apparent in the following Best Modes for Carrying Out Invention and the appended claims. 
     The foregoing objects are accomplished in a preferred embodiment of the invention by a system for monitoring and dispensing medical items in a clinical or hospital environment. This system includes a plurality of item storage locations. A particular type of medical item may be stored in each location. For example, one type of medical item may include a particular type of catheter. Another may be a particular type of medication packaged in a particular dosage. Each location in the system includes at least one unit of the particular type of medical item. 
     A sensor is positioned adjacent to each location. A sensor is particularly adapted to sense the addition or subtraction of a unit of the particular type of medical item that is stored in the location. As a result, each time a unit of the particular item is added or removed from storage in the location, the sensor senses this and generates a signal. 
     A counter is connected to each sensor and records the number of units added or removed from each location. The counter holds a count of the change in the number of units at the location since the last time the counter was read. 
     The counters associated with each location are connected to at least one processor and at least one memory or data store. The data store includes a total of the number of items that are located in storage at the location. Periodically, the processor polls each of the counters and reads the change in the number of units stored therein. Thereafter the processor is operative to update the total number stored in the memory to reflect the number of items currently stored at the location. 
     Embodiments of the invention include a data terminal which includes a user interface and which terminal is connected to the processing system and the counters. The data store includes records concerning patients, procedures, authorized users of the system and each of the products stored in each of the locations, including pricing information. The user, such as a technician or nurse, uses the interface of the data terminal to identify the particular patient who is to receive the medical items taken by the user. Upon removal of the items from the storage locations, the use of such items is recorded in the patient record in the data store so that the patient&#39;s chart may be automatically updated and the item charged. In addition, a user using the data terminal may review information in the data store concerning procedures and physicians to determine what medical items are required by a physician to conduct a procedure and may remove such items for delivery to an operating room. 
     In other embodiments, controlled substances such as narcotics, may be dispensed using the system from a dispenser mechanism or an electronic lock drawer. In such embodiments, the user is required to identify himself at the display terminal. This information is processed and compared to authorized user records in the data store to verify that the user is an authorized user. In some embodiments the identifying information on the user may be placed on an encoded object such as a card and the user may be assigned a personal identification number (PIN) that is memorized by the user. The data terminal includes a reader for reading the coded object and for receiving the user&#39;s PIN number which has a predetermined relationship to the data on the encoded object. The proper input of the PIN with the corresponding user&#39;s coded object verifies that a proper user is requesting to gain access to the items. For some strictly controlled substances two (2) authorized users may be required to input their coded objects and PIN numbers in order to gain access to the controlled items. 
     As with the previously described embodiment, once the authorized user has provided the necessary identification, the processor operates to cause the desired substance to be dispensed or made accessible to the user. The user is also required to input the corresponding patient data so that the patient&#39;s chart and billing may be updated. 
     In some embodiments of the invention, the system may interface with other computer systems such as the admission-discharge-transfer (ADT) computer system that the hospital uses to track patients. This is a computer system which is used in a hospital or clinic to track patient location and activity. In addition, the system of the present invention may also be connected to the hospital information system (HIS) which is the record storage facility of the hospital which maintains computerized records concerning patients. As a result, patient activity, record keeping, and billing may be automated through the system of the present invention, along with inventory monitoring. The system of the present invention may also be used to produce a wide variety of reports from the data store related to patients, authorized users, physicians and various types of items used in inventory. Such a system may also be integrated with an automatic ordering system so as to transfer supplies from one location to another where they are needed and/or to automatically place orders for additional supplies with vendors when supply levels reach a limit. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a side cross sectional view of an inventory monitoring apparatus called a hook register used in the system of the present invention. 
         FIG. 2  is a front cross sectional view of the hook register shown in  FIG. 1 . 
         FIG. 3  similar to  FIG. 1  depicting a medical item being removed from the hook register. 
         FIG. 4  is a partial cut-away top plan view of a further inventory monitoring apparatus of the present invention called a box register. 
         FIG. 5  is a side elevation view of the box register shown in  FIG. 4  as seen along line v-v of  FIG. 4 . 
         FIG. 6  is an enlarged view of the circled portion VI shown in  FIG. 5 . 
         FIG. 7  is a side view of a lever used in the box register shown in  FIGS. 4 and 5 . 
         FIG. 8  is a top plan view of the lever shown in  FIG. 7 . 
         FIG. 9  is a front view of an alternative box register. 
         FIG. 10  is a partial side view of the box register along line  10 - 10  in  FIG. 9 . 
         FIG. 11  is an enlarged side view of a switch and lever of the box register shown in  FIG. 9 . 
         FIG. 12  is a front, partial cut away view of the lever and switch of the box register shown in  FIG. 9 . 
         FIG. 13  is a schematic view of the system for monitoring and dispensing medical items including the hook registers and box registers. 
         FIG. 14  is a top plan view of a dispenser mechanism for vials containing medications. 
         FIG. 15  is a cut-away side view of the dispenser shown in  FIG. 14  with the gate members thereof in a first position. 
         FIG. 16  is a view similar to  FIG. 15  with the gate members of the dispenser in a second position. 
         FIG. 17  is a side view similar to  FIG. 16  with the gate members in a third position wherein a vial is dispensed from the mechanism. 
         FIG. 18  is a cross sectional view corresponding to the dispenser as shown in  FIG. 15 . 
         FIG. 19  is a side view of the dispenser mechanism corresponding to  FIG. 16 . 
         FIG. 20  is a side view of the dispenser mechanism corresponding to  FIG. 17 . 
         FIG. 21  is a side view of the dispenser mechanism and gate members in the positions shown in  FIG. 15 . 
         FIG. 22  is a side view corresponding to  FIG. 21  including hidden edge lines. 
         FIG. 23  is a side view of the dispenser mechanism with the gate members in the positions shown in  FIG. 16 . 
         FIG. 24  is a side view of the dispenser mechanism corresponding to  FIG. 23  including hidden edge lines. 
         FIG. 25  is a side view of the dispenser mechanism with the gate members in the positions shown in  FIG. 17 . 
         FIG. 26  is a side view of the dispenser mechanism corresponding to  FIG. 25  including hidden edge lines. 
         FIG. 27  is a sectional side view of the dispenser mechanism shown in  FIG. 14  located inside a medicine dispenser. 
     
    
    
     BEST MODES FOR CARRYING OUT INVENTION 
     Referring now to the drawings and particularly to  FIGS. 1 and 2 , there is shown therein a first embodiment of an inventory monitoring apparatus of the present invention referred to as a hook register and generally designated by reference numeral  10 . Apparatus  10  includes an elongated housing  12  including an upper wall  14 , a lower wall  16 , side walls  18  and  20 , a front wall  22  and a rear wall  24 . Housing  12  may be formed of any suitable durable material such as plastic or metal. A clip assembly  26  or similar attachment mechanism is desirably carried by a flange  28  of rear wall  24  whereby the housing may be detachably fastened to a rail or similar support structure  30  affixed to a wall  32  or like surface. As will be discussed in greater detail hereafter, rail  30  may also carry a communications bus  34  or other suitable means for electrically connecting the apparatus  10  to a similar apparatus and to a remote computer and data terminal. 
     An object support means is designated by reference numeral  36 . As illustrated, the object support may assume the form of an elongated rigid or angled rod which may be suitably formed of metal or plastic. A shorter leg  38  of the object support means is affixed such as by threaded fasteners  40  to the rear wall  24  of housing  12 . A longer leg  42  of the object support means extends generally longitudinally of the housing  12  and is capable of supporting a plurality of objects  44 . Thus, according to the first embodiment, object support means  36  resembles an elongated peg or rod which suspends objects  44  from holes or perforations  46  provided therein (see  FIG. 2 ). The longer leg  42  of support means  36  also desirably is formed with a raised portion  42 A to prevent the objects from unintentionally sliding off the object support means. 
     It will be appreciated that hook register  10  finds beneficial usage with articles or objects which are suitable for suspension and whose inventory it is desirable to monitor. Typical items may include packages containing medical items such as drugs, medical equipment, supplies, including for example, catheters and guide wires for angioplasty or other medical items which should be strictly and accurately monitored because of theft, safety, critical need or other concerns. For this reason, the object support means may assume any form necessary or desirable to support the objects supported thereby. That is, the object support means may be configured as a rack, multiple hooks or pegs or similar cantilevered members, a tee bar or other such equivalent constructions. 
     A switch actuating means  48  desirably configured as a pivotable lever is mounted generally at its midpoint to housing  12  by a pivot pin  50 . In the preferred embodiment, a first end of lever  48  projects through an opening  52  in lower housing wall  16 . It is also contemplated that lever  48  may be adapted to project through an opening similar to opening  52  and may be provided in any other wall of housing  12  so long as those components necessary for the proper functioning of the apparatus  10  are correspondingly repositioned to accommodate the desired orientation and operation of lever. 
     A second end of lever  48  is connected to suitable biasing means  54  which in the preferred embodiment is a spring. In the preferred embodiment, the biasing means is a tension spring, however in other embodiments biasing means such as torsion springs, compression springs, elastomeric means or the like may be used. The biasing means normally biases the lever to a “inoperative” position in which the lever extends generally traverse to the longer leg  42  of the object support means  36  of the hook register as depicted in  FIG. 1 . 
     It is important that the first end of lever  48  sufficiently project from housing  12  whereby it may be contacted and displaced by a medical item  44  which may be either added to or removed from the object support means. To assure that the lever will interfere with the passage of an object, either into or out of a location on the object support means, a first end of lever  48  is provided with a notch  56 . Notch  56  is configured to receive the longer leg  42  of the object support means  36  therein. As a result, when a medical item is removed from its storage location on the object support means, the object contacts and then displaces the lever so as to rotate it outward. The object then passes the lever and once this occurs the biasing means  54  returns the lever to the inoperative position. 
     A printed circuit board  58  is mounted in the interior of housing  12 . Apart from certain circuitry components specifically identified below which are essential to provide an adequate appreciation of the operation of the hook register, it will be understood that circuit board  58  includes printed circuitry and other circuitry components. 
     Electrical switch means are supported by and electrically connected to the circuit board  58 . During operation the switch means serve as part of a sensor that generates signals indicative of the placement of objects into the storage location on object support means  36  or removal of such objects from the storage location. The preferred embodiment of the hook register utilizes a pair of switch elements  60  and  62  as the electrical switch means. In the preferred embodiment, the switch elements are Hall-effect sensors which change states (off-to-on) when a magnetic field is detected within close proximity. Lever  48  carries a compact permanent magnet  64  which serves as an actuator means. The magnetic field produced by magnet  64  is capable of being sensed by switches  60  and  62  to affect changes in their status. The signals indicating changes in the status of the switches are detected by a signal processing circuit  65  which converts the signals to an appropriate form to be received and counted by a microprocessor  66 . The microprocessor  66  in the hook register serves as a counter which stores a count therein as later described. 
     Operation of the hook register  10  is graphically represented in  FIG. 3 . Specifically, the object  44 , which is preferably a medical item, is shown at the instant in time when it has fully deflected the lever  48  against the force of the biasing means  54  and has just passed the first end of the lever. At this moment, the permanent magnet  64  is pivoted into a substantially facing relationship with magnetic field detector switch  60 . Switch  60  is triggered upon detection of the magnetic field in proximity to the switch element and generates a signal indicating that one object unit has been removed from the object support means  36 . Once the medical item has passed off the object support means, the biasing means returns the lever to the inoperative position. 
     Similarly when a medical item is placed on to the object support means  36 , the lever  48  is pivoted in an opposite direction. This causes the permanent magnet to trigger the magnetic field detection switch element  62 . This generates a signal indicating that one object unit has been added to the storage location on the object support means. Although in the preferred embodiment magnetic field detection switches are used, other suitable switches such as three-way toggle switches, photo sensors, optical encoders, capacitive or inductance sensors and the like may be employed as sensors to achieve and generate the additive and subtractive article registration signals. Likewise, the switch actuating means may assume forms other than a pivotable lever depending on the type of medical item and storage location involved. For example, a linearly reciprocal lever, a flexible flap or noncontact type sensors may be used in other embodiments. 
     The microprocessor  66  receives through signal processing circuit  65  the signals generated by switches  60  and  62 . The microprocessor contains software programs which record and count the state of the switches each time a change is detected. The number and direction of the changes are counted and stored as a count in the microprocessor. In addition, the microprocessor includes a computer program that enables it to be reset upon receipt of signals from a remote location. In the preferred embodiment, the microprocessor also has stored therein a location identifying indicator that is representative of a number and or other data uniquely associated with the particular hook register. Each hook register and other dispensing apparatus in the system of the preferred embodiment has a location identifying indicator associated therewith. 
     The electronic circuitry of the inventory monitoring apparatus also has the ability to communicate its count information to other components of the system of the present invention. In each hook register, the processor  66  is connected through a ribbon cable  68  which is connected with an electrical coupling  70 . Coupling  70  electronically couples with a communication bus  34 . In this manner, circuit board  58  is enabled to receive power from a remote power source and is enabled to transmit and receive data through communication bus  34 . 
     The operation of the hook registers  10  in the inventory monitoring and dispensing system of the of the present invention is best shown with respect to  FIG. 13 . Each of the hook registers is connected to the data bus  34 . Each of the hook registers is connected to the data bus  34 , which is connected to a hook controller shown schematically as  72 . Hook controller  72  includes a processor and a data store therein which are operable to communicate with each of the hook registers  10 . The hook controller  72  is operable to periodically poll each of the hook registers  10  on the data bus. The hook controller reads and receives the count information in each of the hook registers and stores it in conjunction with the location identifying information associated with the particular hook register from which the count was received. After the reading of the count information in the register and transmission of the data to the hook controller  72 , the count information in the microprocessor  66  may be erased so a new count can be started. Alternatively, the microprocessor  66  in the hook register may be programmed to store the count information and the time each such count was generated for a period of time while generating new count information. This can be done to assure that usage of items from any hook register can be recovered even in the event of the failure of a hook controller. While  FIG. 13  shows only four (4) hook registers connected to controller  72 , it will be understood by those skilled in the art that many more hook registers may be so connected on the data bus. 
     As a result of polling each of the hook registers  10 , the hook controller  72  has in its associated processor and data store the count of units taken or added in conjunction with the identifying information associated with each hook register. The hook controller  72  is connected by a further data bus  74  to a data terminal  76 . Of course other hook controllers and controllers connected to other types of registers may also be connected to data bus  74 . The data bus  74  is used to transmit and receive information from the connected controllers to the data terminal  76 . 
     Data terminal  76  includes a display screen  78  which serves as a data output device. In the preferred embodiment, screen  78  is a “touch screen” of the type known in the prior art wherein a user may input data by placing a finger adjacent to icons displayed on the screen. Sensors overlying the screen sense the position of the finger and convert it to input data. As a result, touch screen  78  serves as a graphical user interface which includes a data input device as well as a data output device. Data terminal  76  in the preferred embodiment further includes a card reader  80 . Card reader  80  may be used to read data encoded on a magnetic stripe of a user&#39;s identification card. Of course in other embodiments of the invention other equivalent reader means for reading coded objects or for reading a user&#39;s fingerprints or retina pattern may be used depending on the level of security desired. 
     In the operation of the preferred embodiment of the invention, a medical technician who wishes to operate the system and remove medical items from the hook registers  10  operates the display terminal. The terminal screen outputs a visual prompt for the user to identify himself or herself to the system by input of identifying data. In certain embodiments, the identification may be accomplished by the user inputting an identification number assigned to the user by touching the appropriate numbers on a graphical keypad presented on the screen of the display terminal. In other embodiments, the user may be requested to swipe their card in the card reader so that the magnetic stripe thereon may identify the user to the terminal. In embodiments where high security is required, a user may be requested to input both their card and a personnel identification number (PIN) into the display terminal. The PIN has a predetermined relationship to the data on the card, and the data terminal may be operated further only if a proper card and PIN are input. 
     When a user enters their identifying information at the display terminal, the display terminal communicates through a local area network (LAN)  82  to a remote computer  84  which includes a processor and a data store therein. Computer  84  has preferably greater and faster processing capabilities and more memory than a display terminal. The computer  84  has stored therein information records associated with authorized users, and if the data input by the user at the display terminal corresponds to a record for an authorized user, then the display terminal will enable the user to operate the system. In alternative embodiments of the system, one or more display terminals may have the additional processing capabilities and the additional memory to perform the functions of computer  84 . In such cases the functions performed by the computer  84  may be distributed among the display terminals. 
     Upon further use of the display terminal, the user may access certain information about patients, procedures or physicians which is stored in records in the data store of the computer  84 . In the preferred embodiment, the stored records include information about patients. The user may select a particular patient at the display terminal. This is preferably done by the user scrolling through a displayed list of patient names using “keys” presented graphically on the touch screen. However, other input devices for selecting a patient name may also be used. Upon finding the desired patient name, the user designates that patient&#39;s record by touching the patient&#39;s name on the screen. Thereafter, the user may remove medical items from the hook registers that are needed by that patient. When this occurs, the number of units of each item removed from a particular hook register is stored as a count in the microprocessor in each hook register. This information is then transferred to the hook controller  72  when the hook register is polled, and is thereafter transferred to the data terminal  76  when the hook controller  72  is accessed through the data bus  74  by the data terminal. As a result, data representative of both the patient and the location and number of units of medical items used for that patient is available in the data terminal. 
     When the user signs off the data terminal or selects another patient (indicating that the items for the prior patient have been taken), the data terminal then transmits the information corresponding to the counts and location numbers of the items used for the selected patient through the LAN  82  to the data store in the computer  84 . The computer  84  functions to correlate the count and location numbers with a medical item record which indicates the types of items stored and the location. This provides an indication of what was used for the patient. In addition, the processor and memory in the computer  84  serve to update the record related to the patient to indicate that the items taken were used for the patient so that the patient may be charged therefore. The location records related to medical items preferably includes or may be referenced to pricing information so that patient may be automatically billed. In addition, the computer  84  also updates its records concerning the number of medical items remaining in storage in each location. 
     The computer  84  is operable in the preferred embodiment to maintain a continuous real time record of how many units of medical items are stored in each of the locations. If the number remaining in any location has reached a lower limit, the computer  84  is programmed to provide a warning of the need to replenish the supplies at that location to an administrator terminal or workstation  86 . The administrator&#39;s workstation  86  is also a computer with a processor and data store and is connected through the LAN. It has input devices such as the keyboard and mouse shown and an output device such as the screen shown. The terminal  86  may also have other input and output means such as a touch screen, spoken word recognition, audio output or signal outputs connected to printers or other devices. Of course, the need to replenish the supplies may be indicated on the screen at the administrator&#39;s workstation or in other output locations including the data terminals in the area where the hook registers need to be replenished. 
     In other embodiments, the data terminal may be used to help medical technicians or nurses select medical items for patients. The computer  84  also preferably includes records related to medical procedures as well as physicians in its data store. This information may be accessed at the display terminal by the medical technician or nurse who is obtaining supplies for use in such a procedure. By accessing the stored data records related to the procedure, the technician can read a record which includes information such as the items that are normally used in such a procedure. As a result, the technician may note these items and may remove them from the hook registers while viewing the procedure record to ensure that everything normally needed is transferred to the operating room. In addition, the procedure records may be accessed in connection with a physician record related to a physician who will perform the procedure. Such records may include additional medical items that the particular physician requires to have present in an operating room when conducting a particular procedure. This may include additional medical items or particular types of medical items that the physician prefers. It may also include convenience information such as the particular type of music the physician prefers to have played in the operating room during a procedure or other items that the particular physician prefers to have available. 
     In other embodiments of the invention, computer  84  may be programmed to have in its data store, and may provide in response to a request at a display terminal, a schedule of procedures in a particular hospital operating theater. This enables the medical technician or nurse participating in the procedure to locate the patient scheduled for a procedure using the display terminal, and to access therewith the records related to the physician and the medical items that will be needed for the procedure. As a result, the technician or nurse may go to the hook registers, obtain the necessary medical items and have them immediately charged to the patient&#39;s account. If after the procedure not all of the items that were originally taken were used, the items may be returned to inventory and credited to the patient&#39;s account. This is done by the user identifying himself or herself to the display terminal  76  and again identifying the patient to the system using the touch screen  78  in the manner previously described. Replacing the unused items back on the hook registers  10  automatically creates a record that such items were returned and the patient&#39;s account will be credited in the computer  84 . 
     Because of the large number of records that are stored in the data store of the computer  84  and other connected computers, a large number of reports related to inventory usage may be generated. This can be accomplished by using database software such as Paradox® in computer  84 . Alternatively, other relational database software may be used. Further, because the inventory at each location is monitored, messages requesting transfers of inventory from areas where there are excess units to areas where there is a need can be automatically generated by the computer and displayed at the administrator&#39;s workstation. The computer  84  also keeps a running tally of what has been used by each patient as well as what has been taken by each user and used by patients of each physician. This further allows monitoring of usage and allow potential abuses to be uncovered. The computer  84  is ideally programmed to look for patterns of dispensing activity that have been programmed into the computer&#39;s memory as potential abuses and to display a report thereof at the administrator&#39;s workstation. Such potential abuses may include taking particular items at abnormally frequent intervals. The computer  84  may also be programmed to provide reports from the database concerning what particular users have dispensed during a given time period and what particular physicians have used or prescribed for patients. 
     In the preferred embodiment of the system of the present invention, the administrator&#39;s workstation  86  is used as the primary tool for the monitoring of inventory. The administrator&#39;s workstation is used to program the particular type of medical item stored in the location at each of the hook register and in other types of registers in the system. This is done by creating a record for each location in the data store. The administrator&#39;s workstation is also used to set the level of the minimum acceptable number of units of each item at each location so that an indication may be given of a need to replenish or transfer stock. This is programmed as a minimum for each location, and an indication is given when the minimum is reached. Further, the administrator&#39;s workstation preferably includes electronic ordering capability so that when supplies of a particular item are reduced to a particular level, a purchase order to replenish the stock is sent automatically to the manufacturer. The ordering and source information is also optimally part of or referenced with the associated record with the item in the data store. As a result, the administrator&#39;s workstation is programmed so that when the quantity of an item on hand falls to a particular level, an order is communicated to the manufacturer of the needed item directly over a telephone or other data line via a modem, indicating electronically the item needed, an order quantity and a date by which the items must be received. The order quantity data may be preprogrammed or may be calculated automatically by the computer using a program that generates the order quantity based on rate of use. Likewise, the delivery date may be a programmed time period after issuance of the order, but may also be programmed to be a rush order if the “on hand” quantity has fallen to a second lower level or if the use rate is above a programmed level. 
     The administrator&#39;s workstation may also be used to establish records for authorized users and to set varying levels of security for authorized users at different types of display terminals. Although in the preferred embodiment, the administrator&#39;s workstation is the primary control for the system of the present invention as shown in  FIG. 13 , the hospital&#39;s other computer systems including the admission-discharge-transfer (ADT) system  88  and the hospital information system (HIS)  90  are also connected to the local area network  82 . This enables the patient data in the computer  84  to be input and output to the ADT system  88  and records relating to patient activity or other activities to be received from or stored in the HIS, which is typically the long term data storage facility related to patients. The system may also be connected to other computer systems in the institution such as systems in the pharmacy or dietary and food services. Each of these systems may contain multiple processors and data stores which transmit selected data to and from the LAN  82 . This enables the exchange of data throughout the hospital&#39;s computers which facilitates both record keeping, patient billing and monitoring of its inventory. 
     The hook registers  10  which are optimally constructed for supporting hanging items are only one type of dispensing device that can be used with the present invention.  FIGS. 4 through 6  reflect a further embodiment of an inventory monitoring apparatus designated by the numeral  110 . Apparatus  110  is called a box register as it is optimally adapted to include storage locations for holding boxes or box-like articles. Box register  110  includes an elongated housing  112  including an upper wall  115 , a lower wall  116 , end walls  118  and  120 , a front wall  122  and a rear wall  124 . Like housing  12  of hook register  10 , housing  122  may be fabricated from any durable material such as plastic or metal. Although not shown, it will be understood that a clip assembly similar to clip assembly  26  of  FIGS. 1 and 2  or a similar attachment mechanism may be used to detachably fasten the housing to a wall. Alternatively, apparatus  110  may rest on a level shelf, tabletop or reside in a cabinet. Each box register  110  is connected to a communication bus  74  (see  FIG. 13 ). 
     With regard to the box register, in this embodiment, an object support means is represented by reference numeral  136  which support means may assume the form of a receptacle having at least one or preferably a plurality of compartments or object storage sites  138  which are locations wherein medical items may be stored. In this embodiment, object support means  136  is constructed as a multiple compartment, heavy gage, stiff metal wire rack including a pair of upright truss-like end walls  139 , a plurality of spaced apart storage site divider walls  140  situated between and generally parallel to the end walls  139  and a plurality of transverse members  141  affixed to the end walls  139  and divider walls  140 . The end walls  139  are desirably secured by suitable mechanical fastening means  142 , such as nuts and bolts or the like to lower wall  116  (as shown) or any other wall of the housing  112 . 
     As shown in the figures, the object support means  136  is adapted to support objects  144  of substantially uniform dimensions (one of which is shown in phantom in  FIGS. 4 through 6 ) in a substantially upright orientation. For example, objects  144  may be generally uniformly sized relatively thin boxes or similar packages which may contain various designated types of medical products. The object support means as illustrated is thus capable of supporting an object on four sides thereof, i.e. the bottom, back and both lateral sides of the object (see  FIGS. 4 and 5 ). In this fashion, an object  144  may be removed from the object support means  136  by lifting it forward (to the right as shown in  FIG. 5 ) and/or upward. The bases of the divider walls  140  are situated at a lower elevation than the upper wall  114  of housing  12  ( FIG. 5 ) whereby the objects  144  are caused to be tilted slightly rearwardly such that the back sides of the objects maintain contact with the rear of the object support means  136 . 
     Although the described embodiment of the object support means  136  supports the objects  144  such as boxes in substantially upright or vertical position, the present invention also contemplates rack geometries whereby objects may be supported substantially horizontally, at acute angles or in a staggered array incorporating one or more angular support orientations. Further, the spacing between the divider walls  140  need not be uniform in which case storage sites  138  of variable dimensions may be provided in the same object support means  136 . Of course the object support means  136 , like housing  112 , may be fabricated of metal or from any high strength substantially rigid plastic or other suitable material. 
     Box register  110  includes switch activating means  148 . The switch activating means  148  includes one or more levers pivotally mounted at  150  (see  FIG. 6 ) to housing  112  in a manner described hereafter. The levers  148  correspond in number to the number of compartments  138  which are the storage locations provided in the object support means  136 . A first end of each lever  148  projects from the housing  112  into a respective one of the storage sites  138  and a second end of each lever extends into the housing as most clearly seen in  FIG. 6 . The first end of each lever protrudes from the housing for a distance sufficient to be contacted and displaced by an object  144  when such object is added to the object support means  136 . Biasing means later discussed return the levers to inoperative positions upon removal of an object from the corresponding storage site. 
     Referring to  FIGS. 4 and 6 , as is the case with the hook registers described above, the box registers likewise have printed circuit boards therein designated  158  one of which is shown. Circuit boards  158  are mounted in the interior of housing  112 . Circuit boards  158  include printed circuitry and other circuitry components which are not illustrated or described in detail except to the extent necessary for a proper understanding of the present invention. 
     Electrical sensor means are supported by and electrically connected to circuit board  158 . The sensor means generate signals indicative of the placement of an object onto and the removal of an object from the object support member  136 . According to the preferred embodiment, the sensor means comprises one or more discrete force actuatable switches  160  such as snap-type internally resilient dome switches or other type electrical switches. Switches  160  are spaced apart along the length of circuit board  158  and correspond in number to the levers  148  whereby the second end of each lever operates a separate switch. 
     The switches  160  generate real time counting signals indicative of the total inventory of objects  144  carried by the object support sites which are occupied and those which are unoccupied at any instant in time. Thus when a lever  148  is caused to pivot in one direction by an object that is placed into a storage location, the second end of the lever closes its respective switch  160 . This is reflected by the solid line image of lever  148  depicted in  FIGS. 5 and 6 . Switch  160  in turn generates a registration signal indicating that an object has been placed into the storage location and at which storage site the object has been added. 
     Conversely, when an object is removed from the object support means, the biasing force from the internal resilience of the dome switch  160  returns the lever to its inoperative position as is reflected by the dash line image of lever  148  illustrated in  FIG. 5 and 6  whereby the switch is open. In this position, the switch generates a registration signal which reflects that an object has been removed from the storage location. Additionally, if mechanical switches other than dome type or other similar switches possessing internal resiliency are employed as the electrical switch means, then biasing means such as springs or elastomeric means may be provided to assure that the switches change electrical condition upon removal of objects from the object support means  136 . Alternatively, certain switch types have built-in springs which provide the biasing force. Although dome type switches are used in embodiments of the box registers, other suitable sensor means such as two-way toggle switches, momentary contact switches, photo sensitive switches, capacitive or inductance sensors and the like may be employed to affect the generation of additive, subtractive and object locating registration symbols. 
       FIGS. 7 to 8  show on an enlarged scale a lever  148 . The lever desirably includes a pair of opposed notches  161 ,  162  which generally separate the lever into its first and second ends and, in cooperation with mating slots provided in the front wall  122  of housing  112 , establish the pivotal connection  150  of the lever relative to the housing. Further, each lever  148  is preferably provided with a downwardly sloping lip  163  at the leading edge of its first end to facilitate insertion of the objects  144  into the storage sites  138 . 
     The signals indicating changes in the status of the switches  160  are transmitted by wire or other acceptable signal conducting means  164  whereupon they are detected by a signal processing circuit  165  which converts the signals to an appropriate form to be received and counted by a microprocessor  166 . The microprocessor  166 , like microprocessor  66  of the hook registers  10  described above, contains software programs which record the state of the switches each time a change is detected. The microprocessor  166  also counts and stores a count indicative of the number and direction of changes in state as they occur. Further, the microprocessor  166  includes the unique location identifying indicator associated with each of the storage locations in which any changes in the presence of a medical item have occurred. Alternatively, the microprocessor  166  may keep track of the times such changes have occurred. 
     While not illustrated it will be appreciated that the hook and box registers are preferably remotely powered through the associated bus connections. In other embodiments they may be locally powered. Further, in other embodiments the registers may include LED or LCD displays on the registers for indicating the powered condition of the particular register or the fact of a change in the status of inventory items at the location. Of course suitable LED or LCD indicators may also be used for other purposes such as indicating the particular type of item to be stored, that the register is in a restocking mode, or that the amount of inventory stored in the location has fallen below a critical level. This is accomplished by programming in computer  84 , or programming in the other processors connected to LAN  82  to output such an indication under such conditions. 
     An alternative embodiment of a box register  110 ′ is shown in  FIGS. 9 through 12 . Box register  110 ′ is similar to the previously described box register  110  except as expressly noted herein. The box register  110 ′ includes a plurality of compartments  126  which are separated by divider walls  128 . Each compartment has located therein a lever  130 , which is movable about a pivot  132  (see  FIGS. 11 and 12 ). The lever includes an object engaging leg  123  and a switch actuating leg  133 . The leg  133  is engageable with an actuating projection  134  of a switch  135 . The switch  135  includes an internal spring which biases the actuating projection outward from the switch. The switch operates to change its electrical condition when the actuating projection is depressed. 
     Objects or items such as boxes holding medical supplies are stored in the compartments  126 . The presence of an object in the compartment engages the object engaging leg  123  and moves the associated lever  130  to the position shown in phantom in  FIG. 11 . In this position lever  130  is in abutting relation with a stop member  152  which bounds the rear of the compartment. The stop  152  prevents the object engaging leg of lever  130  from being rotated rearward beyond the position shown in phantom. When object engaging leg  123  is in engagement with stop  152 , switch actuating leg  133  depresses actuating projection  134  of switch  135  resulting in the switch having a first electrical condition. 
     Upon removal of the box or other object from the compartment, actuating projection  134  moves outward in response to the biasing force of the internal spring as the object disengages lever  130 . Outward movement of actuating projection  134  causes switch  135  to change its electrical condition. As in the earlier described embodiment of the box register this change is noted in conjunction with the location information in the box register&#39;s associated microprocessor, similar to microprocessor  166 . 
     Although the box registers shown are a single tiered rack, the object support means may comprise a multi-tiered rack or a plurality of rows and/or columns of cubicles whereby each of the storage sites or cubicles may be appropriately fitted with a switch actuating means such as a lever. 
     In the preferred form of the invention, the box registers are connected through bus  74  with the display terminal  76 . The display terminal periodically reads the count information in the microprocessor  166  associated with each of the box registers and receives changes in the count information associated with each of the storage locations in the box registers. 
     A user may operate display terminal  76  to indicate the appropriate patient for which material taken from the box registers will be used in the manner previously described with regard to the hook registers. In addition, the administrator&#39;s workstation is used in the setup of the system to assign the particular type of medical item to be stored in each location in the box registers which is stored in a record in computer  84 . However, unlike the hook registers which may store a substantial number of units of the particular type of medical item in each location, a box register is adapted to store only one such item in each location. Therefore, in some embodiments several adjacent locations in the box register are designated for containing the same type of medical item. 
     As is also the case with the hook registers, a user of the system who is replenishing inventory to the box registers may operate the display terminal to so indicate using the touch screen data entry device that he or she is replenishing inventory. In this case, the records in computer  84  will be updated to indicate the units of inventory added in each of the storage locations. No patient is credited for the items stocked in the locations and a record in the data store concerning the number of such items on hand but not yet placed for use in a location is also updated. In alternative embodiments, a bar code is applied on the various items stored in the hook and box registers. A bar code reader or scanner shown schematically as  104  in  FIG. 5  is positioned in the hook and box registers so that the code on the item is read as it is placed or removed from a location. The bar code scanner generates signals that are interpreted by software for reading bar codes which runs in computer  84  or another terminal in the LAN  82 . A data store associated with the software includes information which correlates each bar code identifier with a particular medical item. This provides a check that the item actually stored or taken is the type that is recorded as stored in that location. If an error is made an alarm may be given, either at the register, display terminal and/or the administrator&#39;s workstation. Alternatively, the bar code on the medical items may be used to “set up” the system, so that the system records the fact that a particular medical item is stored in a particular location as a result of having read the bar code thereon as the item is placed therein. This avoids the need to program the Administrator&#39;s workstation with this information. The bar code scanner can be provided in addition to the indicator which indicates an item is added or removed. Alternatively, the bar code may be read as each item is removed from a location on a hook or box register and the use for the patient of the item recorded directly in response to reading the bar code signals and identifying the patient at the display terminal. 
     The information included in the data store with respect to particular items may also include a date by which perishable items must be used. The user stocking such items in the locations can input such information using the input device of the data terminal. Items having a limited shelf life are preferably stored in the box registers where the “use by” date can be uniquely associated as part of the record for the only item in the location. 
     The system can also be used with other types of devices that are used to indicate that an item has been taken for a patient. One such device is a manual input register where a nurse or other medical technician manually indicates that an item has been taken. 
     In one embodiment a manual register is structurally similar to box register  110 ′ except that it does not include compartments or levers. The actuating projections of the switches are connected to manually engageable buttons. The system is programmed so that the momentary change in electrical condition of a switch resulting from depression of a particular button represents the taking of one unit of a particular item from storage. Preferably each button is labeled with indicia representative of the item that it is associated with. 
     In the case of a manual register, the nurse or medical technician ques up the patient who will receive the items on the screen of the data terminal and touches the screen to select that patient. The user pushes each button on the manual register corresponding to the type of item taken. By pressing the button once for each unit of an item taken, data is stored in the microprocessor associated with the manual register which is representative of the particular button location pushed and the corresponding count associated with that button. This information is correlated with the patient record in the same manner as occurs with the hook registers and box registers. 
     The system of the present invention may also be used in conjunction with other types of dispensing devices. An example of such a device is an electronic lock drawer  96 . The electronic lock drawer may be used to store narcotics or other articles, the use of which is highly restricted and which are not suitable for storage in a hook or box type register of the type previously described. Alternatively, the electronic lock drawer may comprise a secure enclosure housing hook registers or box registers in its interior. The function of the electronic lock drawer is to hold the restricted items and provide access thereto by opening a locking mechanism of the unit only when a set of predetermined conditions are satisfied. 
     In the preferred form of the invention the electronic lock drawer is connected to and the opening thereof controlled through an adjacent data terminal  98 . Data terminal  98  is similar to data terminal  76 . Data terminal  98  is connected to the electronic lock drawer  96  and is operable to unlock the lock thereto upon receipt of appropriate signals from computer  84 . Of course although only one electronic lock drawer is shown in connection with data terminal  98 , additional electronic lock drawers may be connected thereto. 
     In the preferred form of the invention, information about each type of restricted material housed in each electronic lock drawer is stored in a record in the computer  84 . To gain access to these materials a user must first identify himself or herself to the data terminal in the manner previously described. Preferably for highly restricted items, computer  84  requires not only a user to input an identification card and PIN number but also a second authorized user to input their coded card and PIN number. The purpose for requiring two (2) authorized users to be present to open the electronic lock drawer is so that the items removed and their disposition may be verified. 
     Preferably, the computer  84  has stored in the patient record, information about the medications that the patient has been authorized to be given. As a result, the user may use the data terminal to select the patient name and to request the opening of the electronic lock drawer so the user may take the medication for the patient. This is done using the touch screen of the data terminal as an input/output device. Thereafter, upon proper input of a further authorized user&#39;s verification information, the electronic lock drawer will unlock in response to signals sent from the computer  84  to the data terminal  98  and from the data terminal  98  to the lock drawer  96 . Thereafter, the user may remove the medication from the lock drawer in the presence of the verification user and reclose the unit. Upon the user inputting a verification input to the data terminal that the medication has been taken, the associated record of use and the charge therefore is automatically added to the patient&#39;s account by the computer  84 . 
     It does not matter if a medication that is stored in the electronic lock drawer is not listed as one the patient is authorized to receive in the patient&#39;s records in the computer  84 , the user may still access the electronic lock drawer. A user may input a request through the data terminal for a listing of medications available. In response the computer  84  outputs to the data terminal a listing of the available medications and the dosages. The computer may also provide information on the location of each medication. The user may then select a particular type of medication and then input through the data terminal a request for a listing of patients which again is provided from the records in the data store of computer  84 . By selecting the patient who is to receive the medication (and when appropriate providing the necessary verification from a co-authorized user) the appropriate electronic lock drawer will unlock and allow access to the medication. Upon verification input to the data terminal from the user that the medication has been removed, the computer will charge the patient&#39;s account therefore by updating the patient&#39;s record. Of course as is the case with the other medical item storage locations previously described, computer  84  also operates to keep track of the inventory of various items inside the electronic lock drawer  96  to assure adequate stock. The computer is also programmed to record the users and verification users who have removed items from the electronic lock drawer and the types of items taken so that any shortages or patterns of abuse may be automatically noted. Further, as discussed previously, data terminal  98  may be used to access information in the computer concerning procedures and physicians so that items in the electronic lock drawer  96  may be taken to an operating theater in advance of a surgical procedure. 
     Of course data terminal  98  may be used like data terminal  76  to credit a patient&#39;s account for items returned from inventory as well as to indicate replenishment of inventory in the electronic lock drawer. If a narcotic substance is to be returned the computer is programmed to have a verification user verify the returns. Returns are preferably made into special one way receptacles so that returned items can not be removed by unauthorized persons. 
     Another type of dispenser apparatus that may be used in the system of the present invention is the medicine dispenser  100  shown in  FIG. 13 . Medicine dispenser  100  is also used for dispensing medical items that require high security such as narcotics. However, unlike electronic lock drawer  96 , medicine dispenser is operable to dispense only the particular item requested and to restrict access to all the other items housed within the medicine dispenser. As shown in  FIG. 13  the medicine dispenser is connected to a data terminal  102  that is similar to data terminals  76  and  98 . The operation of the data terminal  102  in conjunction with the medicine dispenser  100  is similar to the operation of data terminal  98  in cooperation with electronic lock drawer  96 . The difference in the use of the medicine dispenser is that in response to selection of the particular medical item (and the co-user verification if required) the medicine dispenser will provide to the user a single unit dose of the particular medical item requested. As a result, the user is not required to locate the item as is required with the electronic lock drawer. In addition, the level of security required for dispense of medical items within the medicine dispenser can be varied depending on the level of security required for the particular item. As a result, for some items in the medicine dispenser  100  it may be necessary only to verify that the user is an authorized user. For other substances, only selected authorized users (and co-users) will be given the substance. 
     The interior of medicine dispenser  100  is shown schematically in  FIG. 27 . Dispenser  100  encloses a plurality of dispenser magazines  168  only one of which is shown. Each magazine holds a plurality of vials  170  which are held in inclined relation in the magazine. Each of the vials in a particular magazine contains a predetermined dose of a substance such as a narcotic material that may be prescribed to a patient. Alternatively, other forms of cylindrically packaged medications or items may be held in the magazines instead of vials. Medicine dispenser  100  optimally houses a large number of magazines, each one holding vials with a particular type of medicine. Each magazine  168  includes a vial dispensing mechanism later described in detail that releases vials in response to electrical signals one at a time from the lower end of the magazine. Released vials are guided on a chute  172  into a pocket  174  in a drawer  176 . Drawer  176  may be a simple drawer or in alternative embodiments may be controllably locked and unlocked by an electronic lock  178  shown schematically inside the medicine dispenser. Each magazine has a dispense verification sensor  179  associated therewith. Sensor  179  is operable to detect the actual dispense of a vial from a magazine. Sensor  179  may be an optical, mechanical or other suitable sensor type. 
     When medicines are requested at the display terminal  102 , the appropriate vials from the magazines  168  are released and fall down the chute into the pocket  174 . After the vials have been released and are in position in the pocket, they may be taken. In alternative embodiments in which the drawer is controlled, the data terminal  102 , in response to signals from the computer  84  unlocks the electronic lock  178  and enables the drawer  176  to be pulled outwardly so that the vials in the pocket may be taken. 
     Replenishment of the medicine dispenser  100  is accomplished by manually replenishing the magazines and indicating that fact through the data terminal. To accomplish this the medicine dispenser has to be opened. This is possible only under the most secure of circumstances and through the use of a mechanical locking system comparable to that which is conventionally used to secure narcotics. Normally, two keys are required to open the unit and each key is in the possession of a different person. 
     The operation of the vial dispensing mechanism is shown in greater detail in  FIGS. 14  through  FIGS. 26 .  FIG. 14  shows the vials  170  in the magazine  168 . As shown in  FIGS. 15 through 17  because the magazine is tilted downward the vials tend to roll towards the front of the magazine toward an opening  180 . The vial adjacent the opening  180  contacts a guide  182  which is dog-legged in cross section. Guide  182  includes a tapered face  184  which is engaged by the first vial  202  in the magazine. Guide  182  further includes an arm portion  186  that extends longitudinally adjacent the vials. Arm portion  186  has attached adjusting pins  188  which extend through the side walls  190  of the magazine. Adjusting pins  188  extend in angled slots  192  and may be fixed at selected positions therein using nuts mounted on the pins or other suitable locking fasteners. 
     The movable mounting of the guide  182  enables the magazine to accommodate different diameter vials by moving the guide in the slots  192  to provide sufficient clearance for a vial to pass onto the guide adjacent opening  180  but not so much clearance so that the vial can fall out the opening without the actuation of the gate members as later explained. As best shown in  FIGS. 18 through 20 , a front gate  194  and a back gate  196  are mounted adjacent to opening  180 . The front gate and back gate are mounted on a front gate shaft and a back gate shaft  198  and  200  respectively. 
     As shown in  FIG. 18  in the inoperative position of the gate members front gate  194  engages the underside of first vial  202  adjacent opening  180 . The end of front gate  94  engages vial  202  at a position outward towards opening  180  from a location on the surface of the vial diametrically opposite where vial  202  engages tapered face  184  of guide  182 . As a result, the vial  202  is prevented from passing out through opening  180 . In this position any force applied to vial  202  (if it could be accessed) would tend to be resisted by compressive forces making it very difficult for the vial to be manually removed. In the inoperative position of the magazine shown in  FIG. 18  the back gate  196  has its upper end extending parallel to a bottom wall  204  of the magazine. As a result, in this position the back gate does not interfere with movement of the vials. 
     In the actuation sequence for dispensing a vial, the back gate rotates in a clockwise direction to the position shown in  FIG. 19 . As it does this the back gate begins to move to a position blocking the vial immediately behind vial  202  in the magazine from moving toward the opening  180 . In the position shown in  FIG. 19  the front gate  194  remains in its original blocking position holding vial  202  in the magazine. 
     After the back gate has begun to rise as shown in  FIG. 19 , the front gate begins to rotate in a clockwise direction toward the position shown in  FIG. 20 . As the front gate  194  rotates vial  202  is no longer held in the magazine and passes out the opening  180 . The back gate having fully rotated as shown in  FIG. 20 , holds the next vial in the magazine from moving until the front gate returns to its original position shown in  FIG. 18 . When this occurs the back gate returns to its original position allowing the vials to roll forward and the next vial is now in the position of vial  202 . 
     In the preferred embodiment of the invention, the slots  192  are oriented such that for any size vial reasonably accommodated in the magazine, the front and back gates are positioned so that the front gate  194  may assume an over-center blocking position in the closed position and the back gate can move to prevent the dispense of more than one vial at a time. This ensures that with each cycle of the front and back gates only one vial is dispensed. 
     The actuating mechanism for the front and back gates is shown in  FIGS. 21 through 26 . As shown in  FIG. 21  the actuating mechanism for the gates includes an electrical solenoid  206 . Solenoid  206  has an actuating plunger member with a pin  208  extending traversely therefrom. Pin  208  extends traversely in a first slot  210  in a first actuator plate  212  which is attached to the front gate  194 . Pin  208  also extends through an opening  214  in a second actuator plate  216  which is attached to back gate  196 . As best shown in  FIG. 22  first actuator plate  212  has a traversely extending finger  218 . In the position of the front gate shown in  FIGS. 21 and 22 , finger  218  engages a detent  220  in the second actuator plate  216 . The purpose of detent  220  is to prevent finger  218  and front gate  212  from moving in a clockwise direction whenever the second actuator plate  216  is in its inoperative position as shown in  FIGS. 21 and 22 . This prevents a person who may gain access to the front of the magazine from being able to deflect the front gate so as to cause the vials to be removed from the magazine. 
     As shown in  FIGS. 23 and 24  the actuation of solenoid  206  by an electrical signal from the data terminal causes pin  208  to move second actuator plate  216  in a clockwise direction. This causes back gate  196  to move upward and detent  220  to disengage from finger  218 . As a result, front gate  194  may move only after back gate  196  has risen so as to block the dispense of further vials. Upon further movement of pin  208  by solenoid  206  the front and back gate move to the positions shown in  FIGS. 25 and 26 . In these positions the front gate is rotated so as to release vial  202  while the back gate is extended fully upward so as to prevent the discharge of the next vial in the magazine. Thereafter, discontinuance of the electrical signal to solenoid  206  returns the gate members to their original positions and allows the next vial to assume the position adjacent to the opening from the magazine. 
     The vial dispensing mechanism of the present invention enables the controlled dispense of one vial at a time from the magazine in response to an electrical signal. This assures that only the requested medication is dispensed. The same magazine may be readily adapted to vials of varying diameter by adjusting the position of guide  182 . The magazine also accommodates vials of different lengths. In addition, the gate members are suitably secure so as to avoid tampering by persons who might attempt to gain access to the interior of the medicine dispenser  100  through the dispenser drawer  176 . 
     The vial dispensing mechanism also assures that the requested medical item has been dispensed. This is assured by using signals generated by sensor  179  to minimize the risk that a dispense will be recorded which has not actually occurred due to a malfunction. Circuitry in the dispenser is connected to the sensor  179  and transmits signals when a vial passes out of a magazine. These signals are checked to see if they are generated when a signal to dispense to the corresponding magazine is given. The dispense of any item from a location and the provision of such item to a patient is only recorded in the computer data store when the dispense is verified by the sensor associated with the magazine. Alternatively, in other embodiments a bar code reader may be installed in the dispenser and bar code applied to the vials to verify not only the dispense but the type of item dispensed. 
     Although in the above described embodiment of the medicine dispenser the gate members are shown as extending the entire width of the magazine, in other embodiments the gate members may have other configurations and may be of different designs so as to extend only a portion of the width. Although in the preferred form of the invention the magazines extend in downward tilted relation in other embodiments they may be arranged to extend vertically. In such alternative embodiments guides may be provided to hold the vials adjacent to plate  204 . Further, the vials may be dispensed in a vertically upward direction through incorporation of spring loading to bias the vials upward in the magazine. A fundamental aspect of the invention is that the gate member which corresponds to the front gate member engages the vial in an over-center position with regard to where the vial contacts the tapered face, and the back gate member moves in synchronized relation with the front gate member to prevent the dispense of more than one vial at a time. 
     The system for monitoring and dispensing medical items which includes the hook registers, box registers, electronic lock drawer and medicine dispenser previously described may also include or be used with other types of devices. These may include automatic dispensing devices as well as manual devices for which the inventory and use information can be input as a matter of practice at a conveniently located data terminal. The system of the present invention is highly adaptable to accommodate medical facilities of varying size. As the system of the present invention is also connected to a variety of computers which include data stores, a wide variety of parameters may be monitored and evaluated so as to avoid conditions of waste, fraud and abuse. 
     Thus the new system for dispensing and monitoring medical items of the present invention achieves the above stated objectives, eliminates difficulties encountered in the use of prior systems, solves problems and attains the desirable results described herein. 
     In the foregoing description certain terms have been used for brevity, clarity and understanding. However, no unnecessary limitations are to be implied therefrom because such terms are for descriptive purposes and are intended to be broadly construed. Moreover, the descriptions and illustrations given are by way of examples and the invention is not limited to the exact details shown or described. In addition, any feature of the invention that is described in the following claims as a means for performing a function is to be construed to encompass any means capable of performing the function and shall not be limited to the means disclosed in the foregoing description or any mere functional equivalent thereof. 
     Having described the features, discoveries and principles of the invention, the manner in which it is constructed and utilized, and the advantages and useful results obtained, the new and useful structures, devices, elements, arrangements, parts, combinations, systems, equipment, operations, methods and relationships are set forth in the appended claims.