Vending machine medicine

For almost seven years, the residents of Pine Bluffs have had only three options for getting prescription drugs: Drive 40 miles to Cheyenne, travel across the border 25 miles to Kimball, Neb., or get them through the mail.

They now have a much closer, more convenient alternative.

Hoy's Drug in Cheyenne, with the help of the University of Wyoming, has opened the first telepharmacy in the state at the University of Wyoming TriCounty Clinic in Pine Bluffs.

Patients simply bring their prescriptions to a pharmacy technician at the clinic. The technician puts the prescription under a video monitoring system so a pharmacist at Hoy's Drug in Cheyenne can read it.

The pharmacist chooses the correct medication on the computer, and it comes out of a 900-pound, bullet-proof "vending machine" back at the clinic in Pine Bluffs.

Through a system of bar codes and checks, the pharmacist makes sure the patient has the correct drug. The technician even shows the pharmacist the actual pills through a video feed, and patients must consult with the pharmacy over the phone or through a video conference.

Dr. Douglas Parks, a family practice physician who works four days a week at the clinic in Pine Bluffs, said the telepharmacy is as safe as any drug store. It has twice as many checks as a retail store.

If a patient needs a medication that is not in the machine, the pharmacy technician will bring it the next morning from Hoy's Drug in Cheyenne and the patient can pick it up at the clinic.

"We are having nine to 10 patients a day who are not having to drive," Parks said. "For a parent who comes in with a sick child, they don't have to bundle up the kid and drive 45 minutes to get medicine."

Jim Massengill, president of Hoy's Pharmacy in Cheyenne, said he had looked at opening a small pharmacy in Pine Bluffs before, but it was just not financially feasible. Massengill said it takes about $500,000 to get a pharmacy up and running.

To open the telepharmacy, Massengill had to buy only the communication systems, the new computers and printers for the telepharmacy and the initial drug inventory. Hoy's Drug also pays the pharmacy technician who works at the telepharmacy.

The actual "vending machine" that holds the medications was purchased through a grant from the UW.

"It's the leading technology," Massengill said. "We already have a lot of technology in place here at Hoy's. It just adds on to what we already do."

Surrounding states have been implementing the idea of telepharmacy for several years. There are more than 20 remote telepharmacies in North Dakota, said Ann Rathke, the telepharmacy coordinator for North Dakota State University.

Parks and Hoy's Drug have been working on this project with the Wyoming Board of Pharmacy since about 2004. At that time, the board could only license a hospital pharmacy or a retail pharmacy, which requires a registered pharmacist on site 80 percent of the time. In 2005, the board drafted legislation to be able to license telepharmacies, and it passed.

The telepharmacy finally began dispensing medications at the end of February but is just now starting to educate the public about the service.

An open house is set from 5 to 7 p.m. today at the clinic for anyone interested in the project.

Tim Seeley, the president of the of the Wyoming Pharmacy Association, said he hopes this is successful because there are a lot of small towns in Wyoming that could use a service like this.

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Telemedicine may be part solution to doctor shortage*

This article out of Australia's ABC, title seems to blame new technology for the shortage of doctors (and other healthcare workers including pharmacists), when in reality the article and the person it quotes says nothing of the sort, and the real life position is obviously the opposite - the shortage of healthcare workers inspires people to come up with new technology (like telemedicine and telepharmacy programs) in order to fill needs.

Pharmacists Shortage

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A national pharmacist shortage is having an impact here in the Central Valley. Because it’s a high paying job, pharmacists often settle in big cities.

Nationally, Wal-Greens opens a new pharmacy every 20 hours. Combined this with baby boomers who are using more prescription drugs and the shortage becomes a big problem.

CBS 47’s Susie Frankeberger takes a closer look at this growing valley issue.

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Indiana Digital Gateway: Just What the Doctor Ordered

An innovative fiber optic network is improving health care in this underserved rural area.

If you drew a diagonal line across Indiana, you would divide the state neatly into two very different regions: the industrial northeast and the largely rural southwest. The southwest, with its low population density, is still struggling to improve its broadband access, health care facilities, and opportunities for economic development. But now a local telecom provider, Smithville Digital – a subsidiary of Smithville Telephone, Indiana’s largest privately owned telecommunications company – has made a commitment to using fiber optics to boost the region’s development.

The company began building its fiber optic network in 2000 for transport, in order to be less dependent on connections with other carriers. And because the investment coincided with the beginning of the tech bust, transport was the network’s only use for several years. But in 2003, as soon as interest in high-speed networking began picking up, Smithville saw an opportunity for selling Metro Ethernet services over its fiber infrastructure. It renamed its network the Indiana Digital Gateway, drew up a business plan and signed its first clients early in 2004.

Today, the Gateway provides high-speed access to health care facilities, schools, city and county offices, an apartment complex and an industrial park. Smithville Digital hopes to add more customers to the network soon.

Jailhouse Telepsychiatry

The Center for Behavioral Health (CBH), a psychiatric clinic whose main office is in Bloomington, Indiana, has a contract with the Monroe County Sheriff’s Office to evaluate and treat prisoners who need mental-health services, mainly for addiction-related problems.

Until last year, deputy sheriffs would bring prisoners to the clinic, then sit and wait for them outside the door of the treatment room. This arrangement kept deputies idle for long periods, created stress for prisoner patients, and alarmed other patients who found themselves sharing waiting rooms with prisoners and armed guards.

After the Indiana Digital Gateway became available, CBH conferred with the sheriff’s office about how to take advantage of it. The clinic’s psychiatrists felt that while in-person meetings were needed for initial evaluations, followup treatments could be done via videoconference, allowing prisoners to stay at the jail. Using the Gateway and a Polycom videoconferencing solution, they set up soundproof rooms at the clinic and the jail and equipped them with cameras, televisions and microphones. In the summer of 2006, they began seeing clients remotely.

"After a few minutes, everyone forgets it's video."

Getting the ergonomics right took some work, says CBH IT director Chuck Stringer, but the work paid off. “We haven't had a single complaint,” he says wonderingly. “After a few minutes, everyone forgets it’s video.”

As expected, videoconferencing saves time – and taxpayer dollars – associated with transporting prisoners to the clinic. It has other benefits as well. Psychiatrists are happier not to be conducting therapy sessions with armed guards at the door. Most important, prisoners receive treatment on a more regular schedule. In the past, treatment schedules depended on the availability of sheriffs to transport patients; when sheriffs were called away on emergencies, patients didn’t get to see their doctors. Today, this happens much less often.

CBH is now considering setting up cameras in all five of its locations. Videoconferencing between locations will help doctors see patients sooner without having to drive several hours round-trip to distant clinics. It will also let doctors supervise nurses and paraprofessionals in remote offices without having to drive there as often.

Long-Distance Radiology

Bloomington Hospital is a regional health care provider with two hospital locations and a network of five family practice offices; its main facility is across the street from CBH in Bloomington. The hospital had previously leased T1 lines from Smithville but by 2003 it was ready to install higher-bandwidth applications than the T1 lines would allow. “We thought it was a good time to talk to Bloomington about investing in fiber as a substitute,” says Cullen McCarty, president of Smithville Digital. “They could do with one strand of fiber what they couldn't do with a thousand T1’s.”

In 2004, Bloomington Hospital became the first client on the Indiana Digital Gateway. Working with its imaging vendor, McKesson, and with Smithville Digital, the hospital installed a system for sharing medical images between the main hospital in Bloomington, the critical-access hospital 45 miles away, and an affiliated outpatient imaging center. With the centralized imaging system, images can now be acquired at any site and read at any site. Highly paid radiologists no longer have to spend hours on the road, and the worst-case turnaround time for readings has been reduced from several days to several hours. “If you're a patient waiting for an answer, that’s really important,” says Bloomington CIO Mark McMath.

The system also automatically retrieves the patient’s prior images so the radiologist can compare them with the current image. Before the central image archive existed, there wasn’t always a way to get prior images in time for them to be diagnostically useful, McMath says. With so much more information accessible today, fewer repeat tests are necessary, which saves time, money and anxiety for patients.

Hosted Services

Bloomington Hospital is also using its fiber infrastructure for applications beyond medical imaging. For example, it is hosting electronic medical records for the emergency room in the rural hospital as well as for the main hospital. “If your case is too complicated for our Orange County hospital and you get sent to the main hospital, your record goes with you,” McMath explains.

The two hospital locations now also share a pharmacy system. This means that the rural hospital doesn’t need to maintain a nighttime pharmacy staff, but doctors there can still write prescriptions at night and have them filled.

Physicians can use the hospital wireless network to access information from their offices.

At the main hospital, the fiber infrastructure also supports wireless Internet access, which physicians use for remote access to their own systems. While ideally it might be best for all local hospitals and physicians to share a medical-records system, this degree of cooperation has so far proved elusive. Helping doctors access their own medical records systems from the hospital is the next best alternative. “It gives you continuity of care,” McMath says. “It simulates having a combined medical record; there's better information at the point of care.”

Platform for Innovation

McMath looks forward to even more integration in the future. He hopes to extend the metro fiber network throughout Bloomington to all doctors’ offices, and maybe even to their homes. Then specialists will be able to view true diagnostic-quality images away from the hospital (they can already see lower-resolution images if they have broadband access), and will be able to exchange clinical information securely and automatically.

Other new systems are in the works, too. Cardiology imaging is being implemented now, to be followed by a lab system and a clinical decision support system. The decision-support system, which will present physicians with relevant medical literature and guidelines, drug-interaction information, and patient lab results, is expected to result in faster and more accurate treatments for patients.

In fact, there seems to be no end to the ideas that McMath and his medical informatics director, Todd Rowland, M.D., have in mind. The fiber optic network has inspired their creativity. McMath says, “What I like is that, as you get higher bandwidth, there are unanticipated things you can do. It’s a platform for innovation.”

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Debuting in Boston: a 250-pound robot to help soldiers stay alive

Hart, 47, has a habit of drawing entrepreneurial energy from the tragedies of life. He was a liberal arts major in college, and later picked up an MBA from the University of Texas. But when his father died in a hospital in 1987, after a nurse gave him the wrong medication, Hart launched Telepharmacy Solutions Inc., a Billerica firm that automatically dispenses medications, using prescription data sent over a computer network. He sold the company in 2002 to AmerisourceBergen Corp. and was planning to take an executive job there.

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Apollo holds tele-medicine dermatology camps in Kutch

APOLLO Hospitals, Ahmedabad organised Dermatology camps at six different locations in Kutch on Monday. Over 30 patients were examined by Consultant Dermatologist Anshul Warman via satellite communication at these camps, after which, individual prescriptions were sent to the consulting centres to be distributed to the patients.

Apollo Hospitals has made arrangements to ensure medicines are made available to patients through its pharmacy network across Gujarat. Medicines will be made available in the region of Kutch with help of the pharmacy at the Mundra hospital.

Apollo Hospitals International Limited in association with ISRO will be spreading awareness about health issues through tele-medicine in remote regions of the Kutch district. The hospitals plans to add more specialties to the tele-communication list. Sessions on Gynaecology, Diabetology and Orthopedics through the use of satellite are also being planned by the hospital.

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Concordia considers pharmacy school

The strong demand for pharmacists has prompted Concordia University Wisconsin to look at the feasibility of its starting a pharmacy school.

The school would mesh well with the university's existing health care programs, such as nursing, occupational therapy and physical therapy, said William Cario, vice president of academics for the university. The question is whether the small university in Mequon can raise the money needed to start a program.

"Pharmacy programs are quite expensive," Cario said.

Concordia University would need at least $5 million to cover the school's start-up costs for the first three to five years, he said. It also would need an additional $10 million to renovate an existing building or add a new one to its campus.

The university's annual operating budget is a bit more than $50 million a year.

"We do not have the resources to do this by ourselves," Cario said.

But he said a pharmacy program would fit well with the school's mission of preparing people for service.

Concordia University has 1,600 students in its traditional undergraduate program and 1,900 in its graduate programs. It also has about 2,000 students in a non-traditional adult education program.

The University of Wisconsin-Madison has the state's only pharmacy school. And the school's graduates have no trouble finding jobs.

"The demand is certainly greater than the supply," said John Gates, a pharmacist and director of retail pharmacy operations for Aurora Health Care. "And given the attrition in the industry, it's an ongoing problem."

Finding pharmacists to work in rural areas is particularly difficult.

Aurora employs 265 pharmacists at 135 retail sites. The health care system also employs pharmacists at its hospitals.

Pharmacists can make more than $100,000 a year - Gates said the average is about $96,000 a year - and increasing.

"From my preceptive, anything that increases access for pharmacy students is welcomed as long as it's a quality program," Gates said.

UW also is considering ways to expand its program, including setting up a satellite program at the University of Wisconsin-Milwaukee or another campus, said Jeanette Roberts, dean of the UW School of Pharmacy.

The school, which graduates about 130 students a year, is a four-year program that requires at least two years of credits before being accepted. It gets 350 to 400 applicants each year for its 130 slots.

A pharmacy school itself requires pharmacists - not to mention people with doctorates in chemistry and pharmacology among other disciplines. And finding faculty would be hard for either school given the existing shortage and rise in wages.

"It's a difficult time to be expanding," Roberts said.

Concordia University knows this.

The school expects to make a decision by the end of the summer. And the earliest it could start a school would be the fall of 2009.

"That would be our best hope," Cario said.

The first class probably would be 50 to 75 students.

Chris Decker, executive vice president and chief executive of the Pharmacy Society of Wisconsin said the group would support another pharmacy school in Wisconsin.

"It will depend on their leadership and their commitment of resources," Decker said. "They can't do it on a shoestring and be successful."

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Schools seek cure for pharmacist shortage

5 state universities plan to open new programs or expand existing ones

By DARREN DUNLAP, dunlapd@knews.com
May 1, 2007

A shortage of pharmacists has five Tennessee universities moving forward this year with plans for new schools and expansions to train more graduates.

The University of Tennessee nears completion of an expansion to its college of pharmacy building in Knoxville for fall 2007.

Dean of the College of Pharmacy Dick R. Gourley, who said there's a shortage of pharmacists in the state, toured the site on the University of Tennessee Medical Center campus Monday. The expansion is on two floors, totals 15,000 square feet, and appears to be coming in on time and budget, he said.

The expansion will allow UT to expand the College of Pharmacy's classes from 125 doctoral students to 200 per year.

Steve Ross, senior vice president for strategic development at UTMC, said UT pharmacy students have trained at the medical center for 20 years. He said it's harder to recruit pharmacy graduates now. The number of pharmacy students has increased, but so has demand for health-care services, he said.

The expansion will allow pharmacy students to take the second, third and fourth years of their doctoral studies, including clinical rotations, at UT's site in Knoxville.

All students will do their first year in Memphis at UT's Health Sciences campus, which recently began construction of an 184,000-square-foot building, Gourley said.

"East Tennessee is going to get some of the best and brightest pharmacy students early on," Ross said.

He said he hopes that means more will take pharmacy positions in East Tennessee once they graduate.

Union University in Jackson, and Belmont University and David Lipscomb University in Nashville, announced plans this year to open pharmacy schools.

East Tennessee State University held an inaugural ceremony in January marking the opening of its school. The school's mission is to train pharmacists for rural, underserved populations.

Larry Calhoun, ETSU's college of pharmacy dean, said many of the students in the university's program come from within 100 miles of the university.

The average class will have about 80 graduates, he said.

"I'm confident the market will support the number of graduates," Calhoun said.

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