Low-Cost Pharmacy Opens in Colchester

Colchester, Vermont - December 15, 2008

Low-income Vermonters will now have access to some of the cheapest prescription drugs in the nation.

The Community Health Pharmacy opened in Colchester. It will serve five of Vermont's seven federally qualified Health Centers, like the Community Health Center of Burlington. Eventually they hope to serve all seven. Primarily, prescriptions will be filled here and mailed to patients at 40 percent to 75 percent off the usual cost. Currently about 55,000 Vermonters are eligible for this service.

"We are increasing access to pharmacy services to most areas where there isn't much access at all... Our inventory is purchased at a ceiling price," said Marc Comtois of the Community Health Pharmacy. "The price that we get is the second cheapest access prescription out there other than Dept of Defense and the VA."

The Community Health Pharmacy is also part of a pilot-project for a telepharmacy controlled auto-dispensing unit.

Through a computer, pharmacists in Colchester dispense drugs through a vending machine in Plainfield and oversee a pharmacy technician there who hands out the meds. It's designed to see if this program could help with a severe pharmacist shortage in Vermont.

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Tennessee draws up new Telepharmacy rules

In a new PDF on the state board's website, Tennessee has drawn up telepharmacy rules for a pilot project.

GLFHC addresses NACHCA regarding telepharmacy

LAWRENCE — Greater Lawrence Family Health Center (GLFHC) recently addressed the National Association of Community Health Centers Annual Conference regarding telepharmacy and how the process has been implemented in the Lawrence-based community health center.

Patrick Grotton, MBA, chief information officer Diane Gatchell, R.Ph, director of pharmacy, and Timothy Hudd, Pharm.D., R.Ph., AE-C assistant professor of pharmacy practice, Massachusetts College of Pharmacy and Health Sciences, Boston, attended the four-day conference in New Orleans and were members of a panel addressing the topic of "Utilizing Telepharmacy Technology to Improve Access to Pharmaceutical Care in a Federally Qualified Health Center."

The three outlined the successes of using telepharmacy in an urban community health care setting.

Source

Nontraditional work schedules for pharmacists

Envision Telepharmacy

Description of the pharmacy.

Envision Telepharmacy is a Texas-licensed pharmacy that provides electronic supervision of pharmacy technician (EST) services for facilities with fewer than 101 beds, remote order-entry (ROE) services, and Pharm-Q, a Web-based system for order scanning and imaging. Services are provided 365 days per year and 24 hours per day. Within the parameters of a given state board’s rules and regulations, services can be scheduled to remotely provide any number of coverage hours on an ongoing or temporary basis. ROE services focus on one task, while EST services involve performing tasks for full-service operations. Pharm-Q products support local electronic order-scanning, ROE, and EST services for facilities and pharmacists who wish to provide or receive remote pharmacy service.

Most of the pharmacists at Envision are married women age 30–50 years with at least one dependent living at home. Twenty percent belong to a minority race, and 40% live in rural areas. The majority have other hospital pharmacy jobs as well.

Groups of three to nine pharmacists provide ROE services, with the majority of pharmacists working fewer than 20 hours per week. In all small and rural facilities currently using ROE services, the hours of coverage occur when there is no onsite pharmacist, typically evening hours and weekends. Service coverage occurs six or seven days each week and ranges from 47 to 92 hours weekly.

EST services are provided by groups of up to four pharmacists. Hours covered are typically daytime and weekday evenings. Service coverage ranges from one to seven days weekly and from 4 to 58 hours per week. Most pharmacists who cover EST services work more than 40 hours per week.

Serviced hospitals range from very small rural facilities to large urban facilities, and the level of onsite technology in place at the facilities varies enormously. For example, the smallest facility using EST services has 4 beds and no automation and lacks a computerized order-entry system. In contrast, a >350-bed ROE facility is heavily automated, utilizes pharmacy robotics, and has a completely paperless medication-order-processing system. For the purposes of this article, discussion will be limited to small (fewer than 101 beds) and rural hospitals.

Small hospitals currently receiving Envision’s ROE services range from a bed size of 29 to 100 with 1–11 onsite pharmacists. Onsite pharmacy operation is provided 40–93 hours weekly during weekdays. Directors of pharmacy in small hospitals often perform some or all of the pharmacy staffing duties in their departments. When staff is short, it is usually pharmacy leadership that must fill in for staffing vacancies. They are generally faced with a comparable number of administrative tasks as their counter-parts in larger facilities and have less support staff to accomplish them. When they fulfill staffing duties, their administrative work waits.

EST services are used in facilities with 4–40 beds and where consultant pharmacists are onsite fewer than five days per week or in facilities with a full-time pharmacist onsite but that wish to extend their hours of operation into the evenings or weekends. The smallest hospital receiving EST services is staffed with a consultant pharmacist who is present one day weekly, while the hospital with the largest staff receiving EST services has 1.5 pharmacist FTEs. Onsite pharmacist-directed operation is provided 4–40 hours weekly. Full pharmacy operation (onsite plus remote) is provided 8–58 hours weekly.

Creative schedules. For Envision Telepharmacy, the schedule is created by a central scheduler. Technology is used to collaborate, coordinate, confirm, and view shift coverage. Envision’s scheduling philosophy includes the idea that pharmacies should be staffed in a manner that the workload during a shift enables pharmacists to take care of all medication-related issues in a timely manner and that the onsite pharmacist can return to work without any leftover tasks. Consequently, more staff may be scheduled during higher-volume hours. Coverage requested by a hospital in addition to its usual coverage and any open shifts are filled by the pharmacists on a first-come, first- served basis.

As long as the coverage needs of the facility are met, almost any scheduling arrangement preferred by individual pharmacists and/or the pharmacist group covering the facility is acceptable. Staffing involves a great variety of shift lengths and intervals. Shifts range from 2 to 10 hours. The shortest workweek is 2.5 hours for a single pharmacist, and the longest workweek is 63 hours for pharmacists who work schedules of seven days on and seven days off.

There is also considerable variation in terms of cross-training between pharmacist groups for individual pharmacists or for cross-coverage of multiple facilities. Pharmacists may choose to work for one facility on some of their shifts and for another facility on other shifts or simply always work for a single facility.

Seventy-four percent of Envision pharmacists rated their satisfaction with their work as a 5 on a scale of 1 to 5, where 5 represents a rating of very satisfied. To date, no pharmacists have initiated termination of their working relationship with the program. Some pharmacists work from the pharmacy (Envision Telepharmacy), while others work remotely using the Envision website as a virtual site from which to provide services. Experienced hospital pharmacists who wish to reduce their time commitments in their careers find remote work a suitable practice. In addition, pharmacists who frequently relocate can continue to keep the same work schedule and work site.

Workload reports and errors are tracked for Envision pharmacists both during the start-up phase of services and on an ongoing basis. Error rates during the three-month start-up period range from 0.12% to 0.5%, and ongoing error rates range from 0.02% to 0.06%. For facilities willing to share their internal error rates and turnaround time reports, the Envision Telepharmacy’s error rate and turnaround time are the same as or, more frequently, below those of the onsite pharmacists. Pharmacists periodically receive reports on their workload volumes and turnaround times along with comparative data for the facility. The high-tech workplace gives pharmacists with interests in information technology an opportunity to work with cutting-edge technology. Ease of access through a Web-based electronic order-management system allows for communication with the nursing or pharmacy technician on

duty at the serviced facility as well as the returning onsite pharmacy department staff. Technology offers pharmacists an opportunity to experience work in a specialty practice area to which they might not otherwise have geographic access.

Scheduling philosophy varies regarding onsite and remote staffing among the serviced hospitals. Some facilities use remote services due to lack of availability of a pharmacist in their area, some regard remote staffing as a way to provide partial or full services during lower-volume hours at a reduced cost, and some wish to extend hours of service by using remote pharmacists. Hospitals may utilize remote services to supplement their onsite staffing in order to free up time for the onsite pharmacists to provide clinical or administrative duties, or simply to take the order-entry burden off of the onsite staff during high-volume hours or periods of pharmacist shortages. Even if the pharmacy leader does not routinely staff the pharmacy, remote pharmacists can be used to staff a pharmacy department during the temporary pharmacist shortage that may occur during holidays, vacations, continuing-education attendance, sick time, and family and medical leave.

Rural hospitals use remote services to comply with regulatory or accreditation agencies, as well as to increase patient safety with the use of experienced hospital pharmacists and increased prospective review of medication-related processes. To more successfully recruit and retain onsite pharmacists in their pharmacy departments, rural hospitals use remote services with the goals of eliminating or greatly reducing the volume of after-hours calls to the hospital’s on-call pharmacist and allowing the onsite pharmacist to return to the department with work caught up and documentation intact on activities occurring since his or her departure.

The most common scheduling philosophy adopted by facilities desiring EST services is that patient safety is enhanced when the medication-related processes of the hospital are prospectively reviewed and controlled by a remote pharmacist rather than by nursing or unsupervised pharmacy technicians coupled with retrospective review by an onsite pharmacist. The philosophy often encompasses the belief that consultant pharmacist time spent on retrospective review of supportive personnel can be eliminated or greatly reduced and that this time can be spent on departmental management and administration, regulatory and quality processes, staff education, and cost-saving clinical activities. The cost of EST services is reliably less than the cost of an onsite pharmacist. For facilities with a full-time pharmacist, this staffing model can be most cost-effective during evening or weekend hours or to fill needs during a short shift. For a facility with less than a full-time on-site pharmacist primarily providing retrospective review of limited pharmacy activities (order review, medication removal from the pharmacy by non-pharmacists), the service can affordably shift the activities toward prospective review and full pharmacy services.

Challenges. Due to the nature of remote work and the hours the pharmacists typically provide service, administrative staff are lacking in frequent face-to-face interactions with pharmacists. As well, pharmacists who work together may not have even met face-to-face. For administrative staff, excellent telephone and electronic communication skills are essential to successful operation of the service and in building a relationship with the pharmacists. Communication systems are in place for the pharmacists both to communicate facility-specific information and to collaborate with one another while on duty. Camaraderie and team building are evidenced through use of those systems by the pharmacists and the rapid filling of open shifts.

Scheduling of the pharmacist staff is complex. The large variation in preferences for shift lengths and the number of pharmacists and facilities, along with numerous licensure and split-shift combinations, present an ongoing challenge for the central scheduler. Changes to schedules or requests for additional hours with short notice are difficult to fill. Electronic communication systems are in place for schedule posting, viewing, confirmation, and review.

Not all pharmacists are well suited to provide remote services. Pharmacists who are self-motivated, like independent work, and have the ability to learn about and become comfortable with the capabilities and limitations afforded by computer technology can thrive in this practice setting.

EST service is not, nor is it designed to be, as efficient as an onsite pharmacist. An adequate technician staff, as well as on-site pharmacist and administrative support, is essential to the success of this practice model. Attempts to utilize this service in a busy environment are self-limiting, since facilities whose medication volume warrants a full-time pharmacist over long periods of time simply cannot be served adequately by this practice model. Although satisfaction surveys have not been distributed, feedback received from nursing is consistently positive or neutral, with the following exception: in facilities with rapid onsite dispensing times (<15 minutes) for medications that must be supplied from the pharmacy, the relative wait time for medication to be delivered to the floor is increased. For example, in a small facility, a delivery time of 30 minutes for a new medication ordered for a patient before discharge may seem unacceptable to a nurse, even though the pharmacy may be feeling the pressures of being in the first hour of operation for the day and of the morning medication pass due within the hour.

Discussion

These case studies present several examples of how unique and alternative work schedules can be integrated into the day-to-day operations of health-system pharmacies. The most recent ASHP staffing survey found pharmacist and technician turnover rates of 9% and 12.4%, respectively, and 48% of respondents were considering nontraditional staffing solutions in an effort to recruit and retain staff.7 While no two hospitals or pharmacy practice environments are exactly the same, it is up to each pharmacy practice manager through collaboration with the staff to come up with solutions that can meet the needs of the changing pharmacy work force.


Conclusion

Compressed workweeks, job-sharing, and team scheduling were the most common types of alternative work schedules implemented at three different institutions.

References

1. ASHP Task Force on Pharmacy’s Changing Demographics. Report of the Task Force on Pharmacy’s Changing Demographics. Am J Health-Syst Pharm. 2007; 64:1311-9.

2. Mott DA, Doucette WR, Gaither CA et al. Pharmacist participation in the workforce: 1990, 2000, and 2004. J Am Pharm Assoc. 2006; 46:322-30.

3. American Society of Health-System Pharmacists. ASHP long-range vision for the pharmacy work force in hospitals and health systems: ensuring the best use of medicines in hospitals and health systems. Am J Health-Syst Pharm. 2007; 64:1320- 30.

4. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2005. Am J HealthSyst Pharm. 2006; 63:327-45.

5. Deal JJ. Retiring the generation gap: how employees young and old can find common ground. San Francisco: Josey-Bass; 2007:144-71.

6. Proctor C. Flex appeal: it’s all in the planning . www.ama-assn.org/ amednews/2007/08/13/bisa0813.htm (accessed 2007 Oct 13).

7. Schecklehoff DJ, Bush C. 2006 ASHP pharmacy staffing survey results. www.ashp. org/s_ashp/docs/files/StaffSurvey2006.pdf (accessed 2008 Aug 20).

Source

Telepharmacy service instituted in Barry's Bay hospital

St. Francis Memorial Hospital in Barry’s Bay has solved its pharmacist problem by using a telepharmacy service. Kevin McDonald, manager of the Hospital Pharmacy Telepharmacy program for the North West Company, and pharmacist Monique Yurkiw work with Joan Kuiack, Director of Patient Care Services at the hospital and (seated) Joan Sullivan, pharmacy technician to test the system. Heather Kendall

The shortage of health care professionals across the province has made it difficult for small rural hospitals to offer the services needed. For the past 18 months, for example, St. Francis Memorial Hospital in Barry’s Bay has been trying to find a pharmacist, without luck.

But it has now solved the problem by connecting with Northern Pharmacy Limited (a division of The North West Company), which offers telepharmacy services.

“A small hospital can safely operate a medication storage and distribution system for their patients under the management of a registered nurse,” says Joan Kuiack, Director of Patient Care Services. “However, the addition of a pharmacist offers an enhanced quality of care to our patients.”

A pharmacist has the expertise to look at the whole patient, his or her disease and relate the effectiveness of the medication they are receiving to their progress, she adds.

The hospital first contacted Kevin McDonald, manager of the hospital pharmacy telepharmacy program at Northern Pharmacy, about a year ago, but decided to try to organize a partnership with Renfrew Victoria Hospital for services of a pharmacist.

“We advertised nation-wide, but couldn’t find a pharmacist and so we went back to Kevin,” says Kuiack.

The North West Company is based out of Winnipeg; the Northern Pharmacy provides similar services to hospitals in areas such as Deep River, Cornwall and Moose Factory. McDonald, who hails from Deep River, initiated the telepharmacy project in 2004.

“A hospital pharmacist is very different from a retail pharmacist,” he says. “In smaller hospitals, there is not enough work to employ a pharmacist full-time, so it’s hard to attract them. We fill that need.”

Monique Yurkiw, a pharmacist with the company since July, will look after St. Francis Memorial. She and McDonald were at the hospital last week to test the system.

“It’s good,” she says. “We’re set to go.”

When a patient is admitted to hospital, order forms for medications are written up and the pharmacist technician enters the information into the patient profile on the computer, and then prints up labels and dispenses the drugs, which go to the nursing unit. Under the new system, the order forms will be scanned to Yurkiw. She will verify the order, ensure the medication, dosage and strength are appropriate; she can watch for possible drug interactions, misinterpreted drugs, or duplicates.

“It’s really a clinical review,” says Darlene Sernoskie, the hospital’s director of operations. “She can also look at lab results online. If there is an issue, she can contact the physician or nursing staff.”

Yurkiw will work from a computer terminal in her home office in Kemptville and will have direct contact with the pharmacy technician working in the St. Francis pharmacy. She will sit on the pharmacy and therapeutics committee and expects to visit the hospital once a month. When she comes to Barry’s Bay, she will attend meetings, review the pharmacy stock and check batch refills for long-term care patients. She’s excited to be connected to this hospital.

“I do some other locations, but this is my site,” she says. “I like the sense of belonging, of being a part of the team.”

“Monique fits in well,” says Sernoskie. “This is a proven system that addresses the national shortage of pharmacists and allows us to enhance the quality of care we offer to our patients. We’re excited.”

The physicians are also happy to have Yurkiw on board.

“The pharmacist is an important support to the physicians and plays a vital role on the health care team,” says Dr. Denise Coulas. “There is no doubt that the right combination of medications is a large part of the treatment plan while in hospital. A pharmacist works with the physicians and staff to provide effective care and a safe transition after discharge.”

Telepharmacy is a first for reservation

TWIN BUTTES A ribbon-cutting ceremony for the opening of the Three Affiliated Tribes telepharmacy will be held Wednesday at 10 a.m. in the Minne-Tohe Health Center's satellite clinic in Twin Buttes.

The opening of the telepharmacy is a first for the Fort Berthold Reservation.

There will be a prayer offered by tribal elder Edwin Benson and an open house at the telepharmacy from 10 a.m. to 2 p.m.

A traditional meal will be served at noon in the Twin Buttes Memorial Building followed by a health fair.

"This is a historic day for the people of the Mandan, Hidatsa and Arikara Nation. The telepharmacy project is a major step toward improving the quality of patient care across the Fort Berthold Reservation," said Stella Berquist, chief executive officer of the Three Affiliated Tribes Minne-Tohe Health Center at New Town. "Health care professional of the Three Affiliated Tribes have been working diligently over the past few months to make this dream a reality."

Here's how telepharmacy works:

Through the use of state-of-the-art telecommunications technology, pharmacists are able to provide pharmaceutical care to patients at a distance. A licensed pharmacist at a central pharmacy site supervises a pharmacy technician at a remote telepharmacy site through the use of video conferencing technology. The technician then prepares the prescription drug for dispensing by the pharmacist.

The Twin Buttes clinic is the main office of the telepharmacy project on Fort Berthold. Other pharmacies will be opening in Mandaree, White Shield and Parshall.

Donna Bieri, a pharmacist from Dodge who has nearly five years of experience working with telepharmacy, will be working on a permanent basis at the Twin Buttes telepharmacy. She will travel to each of the other sites at least once a month.

The pharmacies in Mandaree, White Shield and Parshall are expected to open in about four to six weeks.

The telepharmacy project is a project of the Minne-Tohe Health Center, tribal business council and Twin Buttes Segment.

Source
This seems to have been summarized and distributed to limited AP press outlets: here & here

Treating sick kids has become easier

Telemedicine program lets nurses connect ill students with health providers

Michael Patrick
Patricia Hess, a nurse, is working at Seymour Middle School under an agreement between Sevier County Schools and Cherokee Health Systems to provide medical services to students. The telemedicine program is linked via two-way camera to a physician’s assistant in Knoxville for instant evaluation of the patient.

As the Seymour Middle School student sat in front of the large monitor, his image appeared on the screen.

Using special equipment, the school nurse checked the seventh-grader's ears and throat while a two-way camera simultaneously transmitted real-time video 15 miles away to the medical offices of Cherokee Health System in Knoxville.

"The student has been seen. He is able to stay in school, and the parent doesn't have to leave work," said Olga Eisenhower, one of two Cherokee Health nurse practitioners hired in August for a new telemedicine program launched this month in partnership with Sevier County schools.

Available in 17 Sevier County elementary and middle schools serving approximately 9,700 students, the Internet-based program provides on-site medical services using state-of-the-art technology to connect sick students with a medical provider who can examine, diagnose, treat and monitor them.

Lab testing for strep throat and influenza will also soon be available at each school.

It's a project that school officials hope will promote healthier and happier students and ultimately improve attendance and graduation rates.

"If we can take care of a child's basic well-being, then we can not only maintain academic excellence but improve upon it," said Don Best, coordinator of school health.

Best and Director of Schools Jack Parton turned to Cherokee Health, a safety-net provider serving mostly low-income residents and the uninsured with a decade of experience in telepsychiatry. Cherokee Health is also in the process of piloting a telepharmacy program.

It uses teleconferencing equipment and high-speed telephone lines to allow the clinician and patient to see and speak to each other as if they were in the same room.

The latest project, estimated at $1 million, is an investment in equipment and staff, with Sevier County schools and Cherokee Health splitting the cost. They expect to recover some expenses through private insurance claims and grants.

"It's about access to care. This project knocks down some of those financial, transportation and time barriers," said Joel Hornberger, Cherokee Health chief operating officer.

More than 50 percent of the students in Sevier County schools are on free and reduced lunch, and many parents work in the service industry. That means every hour away from work is an hour of not getting paid, Best said.

Schools such as Caten's Chapel, Wearwood and Pittman Center elementary schools aren't located in close proximity to health care providers which also makes access to care difficult. And some parents, he added, don't always follow the recommendation of the school nurse.

"We are not trying to take patients away from primary care physicians. We are trying to complement and be an adjunct to them," Eisenhower said.

Of those students who will visit the school nurse, Best said he expects about 20-25 percent will require telemedicine. Parents must sign a registration form in order for their child to take advantage of the program.

Standard deductibles apply. Those without health insurance pay $5 as well as a minimal charge for any lab services that may be required.

"I think it's groundbreaking," Best said. "I was very surprised with what you could do with telemedicine."

Business writer Carly Harrington may be reached at 865-342-6317.

Source

Telemedicine Lobbyists Meet with North Dakota State Legislators

An excerpt from Senator Tom Seymour's blog:

Mr. Howard C. Anderson, Executive Director, State
Board of Pharmacy, provided information regarding
health information technology. He said North Dakota
State University has received a federal grant relating
to telepharmacy, and the university has awarded a
contract to Catholic Health Initiatives to implement a
telepharmacy program. He said the telepharmacy
program consists of a central site where pharmacists
and technicians receive information regarding orders
for drugs from the prescribing physicians in rural
health care facilities. He said the orders are reviewed
by the pharmacist using the specific patient's
information. He said the project would function more
effectively if the pharmacist could access the patient's
medical record at the facility and enter the
recommendations or approval directly into the record.
A copy of the information presented is on file in the
Legislative Council office.
Ms. Kimber Wraalstad, President and CEO,
Presentation Medical Center, Rolla, provided
information regarding health information technology.
She said health information technology is important to
increasing the quality of patient care. She said health
information technology applications are expensive to
implement and maintain. She said several North
Dakota critical access hospitals in the state are
experiencing operating losses and are not able to
purchase health information technology applications.
She said hospitals in Bottineau, Rolla, and Stanley are
working together on health information technology
projects and 10 health care facilities in the northwest
part of the state have formed the Northwest Alliance
for Information Technology Projects to research and
implement health information technology applications.
A copy of the information presented is on file in the
Legislative Council office.
In response to a question from Senator
Christmann, Ms. Wraalstad said hospitals rely more
on each other for assistance with health information
technology because the North Dakota Healthcare
Association and the North Dakota Long Term Care
Association do not have expertise in health
information technology.

Telepharmacy Project Expands

It's been six years since the first telepharmacy in Texas opened up in the small town of Turkey, but only a few more have popped up since then, according to Texas Tech University, which says it is looking at ways to increase interest in telepharmacies.

Telepharmacies have real drug stores and allow customers to talk to a real person connected to a pharmacist by the Internet.

Don Turner, who runs the pharmacy in Turkey, says his clients are mostly elderly people who don't have access to transportation.

The nearest pharmacist to the town of 400 people is about 50 miles away.

Debbie Voyles, director of telemedicine at Texas Tech, says the school is now watching a telepharmacy program in North Dakota that started with 10 volunteer sites in 2002 and has grown to 67 locations.

Voyles says she's hoping to learn from North Dakota's success.

Texas is among at least nine states that have changed laws to allow for remote pharmacies.

Source

Texas Posts Grant Notice

The Texas Office of Rural Community Affairs (ORCA) has posted information on the Texas Rural Health Technology Grants for FY 2009. This grant program supports the development of clinical systems and capital equipment for Critical Access Hospitals. ORCA seeks projects that will address at least one of the program goals and at least one of the objectives.

The goals are to expand access to care in rural areas, improve the quality of care and patient safety, provide more efficiency in delivering, coordinating, and integrating healthcare, and improve hospital finances and sustainability.

The program objectives are to implement HIT, EHRs, telemedicine or telepharmacy applications, expand access to health services, reduce health disparities, improve workflow and productivity, enhance hospital viability, and provide for cost efficiencies.

Specifically, the funds are to provide EHRs, physician ordered entry systems, bar-coding systems, data or laboratory information systems, IT/MIS applications, telehealth, telemedicine, telepharmacy, or tele-education. Funds can be used for medical laboratory imaging technologies or services, to improve hospital performance, and produce quality improvement systems or tools.

Only Critical Access Hospitals in Texas that have not been awarded the ORCA Technology Grant in FY 2008 are eligible to apply for the FY 2009 grants. The grants are supported by the Medicare Rural Hospital Flexibility Grant Program and will be awarded by HRSA. A total of $150,000 is available for this program and grants will not exceed $30,000 per grantee. The deadline for the grant applications is December 5, 2008.

For more information, go to http://www.orca.state.tx.us/, or call 1-800-544-2042, or 1-512-936-6701.

Source

Melissa Memorial staff gets high marks in state surveys

By April Peregoy

Melissa Memorial Hospital was the subject of three surveys that took place during the month of September. Reporting at the East Phillips County Hospital Board meeting Tuesday, Sept. 23, administrator John Ayoub was happy to announce the hospital performed very well on all three surveys.
The first was a state survey conducted to make sure the hospital was meeting all the conditions of participation. Ayoub said the survey went well, and he gave staff members a lot of credit for their hard work and cooperation.
Only three minor deficiencies were found, all of which had to do with administration and paperwork areas and not with healthcare procedures.
The first revolved around conflicting policies caused by outdated paperwork that had not yet been upgraded. Ayoub said the hospital is working on bringing all their policies up-to-date. The hospital was also told the Chief of Staff needs to sign off on each department policy.
MMH was also marked down for not currently having an outreach site for pharmaceuticals. This is due to the recent cancelation of the hospital board's contract with Banner Health. The situation is only temporary however, as the board is working on finalizing a contract with Poudre Valley Hospital of Fort Collins to provide telepharmacy services.
Ayoub also pointed out MMH is not the only hospital in this situation, as five other hospitals in northeast Colorado are affected as well.
A follow-up Life Safety Survey was also conducted over the past month. This survey is more facility-focused and is done to make sure all emergency equipment such as emergency doors, fire alarms and fire extinguishers are working properly.
The survey was actually conducted in February and a number of things were found that needed to be corrected. Checking back in to make sure MMH had followed up on these corrections, the September survey found the problems had been fixed.
The final survey was the State Vaccine For Children Survey, which was conducted in the Family Practice Clinic. It is done to make sure the clinic is performing and storing vaccinations properly. Again, Ayoub reported the clinic performed well on the survey.

Staff transitioning to new
electronic record system
The hospital is now beginning the process of switching to an electronic medical records system. According to Ayoub, the first phase of the transition began on Oct. 1 and involves the implementation of practice management software.
After a 90-day training cycle with the new software, the hospital will transition into the electronic record system in early 2009.
Ayoub said the system will greatly benefit patients because their medical charts can be accessed right away. It will also allow the hospital to do its own billing rather than rely on another company to do it for them.
In August, a new documentation form was implemented to help the staff transition into the new system. Chief of staff Dr. Dennis Jelden told the board Tuesday night the new forms have been a big help and the staff is adjusting well to them.
Another computer system purchase request the board is considering is for a claim scrubber. This is a computer application that detects errors made in a claim before it is sent to an insurance company. The purpose is to reduce claim denials due to technical mistakes.
Ayoub said the application could cost as much as $30,000, but would benefit the hospital in the end by improving the efficiency of the payment process with the insurance companies.

Special meeting scheduled
EPCHD will hold a special meeting Tuesday, Oct. 7 to discuss and approve changes recently made to its Ends Statement. The board felt the policy was too important to make a quick decision on it, and wanted some time for review.
A public hearing on the hospital board's budget for 2009 will take place at its next regular meeting, which is scheduled for Tuesday, Oct. 28.

Other business
In other business Sept. 23, the EPCHD board:
-toured the laboratory and heard a general report from lab director Deb Taytum on the department's services and staff.
-was informed Tuesday night Dr. Scott J. Hadley, who treats patients needing emergency dental care, will no longer be available to the hospital. The board is now searching for another dentist in the area to provide this service.
-approved a lease with Harry Sprague to farm the 20-acre empty lot behind the hospital. Ayoub said this was done to save time and money on mowing and to be respectful of the surrounding neighborhood.
-reaffirmed the hospital's policy that EMS attention will be given to all calls that come in, regardless of whether the emergency site is located within district boundaries.
-was informed the hospital had its first on-site helicoptor landing. Ayoub stated some complications did occur, but that it was a good learning experience and next time the staff will be even better prepared.
-canceled its contract with the company that provides the hospital with its Spanish-language phone line. A new contract has already been signed with a different company.
-signed a contract to upgrade and improve the hospital's website. Once the initial upgrades have been made, Ayoub said it is his desire to have a staff member trained to maintain the website.
-was notified the hospital received a $9,000 SHIP grant. MMH is also seeking an emergency preparedness grant.
-heard a presentation from the MMH Foundation that the board is expected to close on a loan in October for the donor recognition wall and MMH history wall.
-approved a bid from EIDE Bailey to provide the hospital's auditing services.
-heard a report from FBLA member Samantha Redfern on the progress being made on the clock tower project. The report showed the club still has $17,000 to raise for the project.
-held a 30-minute executive session to discuss the sale of the old building.

Source

Telepharmacy owes a lot to Sen. Dorgan

As dean of North Dakota State University’s pharmacy program and director of the North Dakota Telepharmacy Project, I was pleased to see the recent AP article published in The Forum on our telepharmacy program. This program is the first of its kind in the country, and it shows what North Dakota is capable of accomplishing when academia works together with rural communities and private businesses to achieve a common goal.

The purpose of the North Dakota Telepharmacy Project is to restore, retain or establish pharmacy services in medically underserved rural communities of North Dakota through the use of telepharmacy technology. Through this program, a licensed pharmacist at a central pharmacy site supervises a registered pharmacy technician at a remote telepharmacy site in the processing of prescriptions for patients. Currently 67 pharmacies are involved in the project – 22 central pharmacy sites and 45 remote telepharmacy sites. Of the 67 pharmacies involved, 44 are retail pharmacies and 23 are hospital pharmacies.

Twenty-nine (55 percent) of North Dakota’s 53 counties are involved in the project and two in Minnesota. Approximately 40,000 rural residents have had pharmacy services restored, retained or established through the North Dakota Telepharmacy Project since its inception in 2002. The project has restored valuable access to health care in remote medically underserved areas of the state and has added more than $12.5 million annually in economic development to the local rural economy.

The only thing missing in this article was acknowledgment of the important role Sen. Byron Dorgan, D-N.D., played in making this program possible. Through Dorgan’s efforts on the Senate Appropriations Committee, he helped provide more than $3.3 million in federal support to NDSU to ensure that this program became a reality.

I can honesty say that North Dakota would not have this nation-leading telepharmacy program today without Dorgan’s help. Considering the impact this program has had locally, regionally and nationally, I believe Dorgan deserves some credit and recognition for his efforts regarding this terrific program.

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Info on Author: Charles D. Peterson, Pharm.D., Dean, Professor, and Principal Investigator
North Dakota State University College of Pharmacy, Nursing, and Allied Sciences
Info on Dorgan: http://www.votesmart.org/bio.php?can_id=53332

Pharmacy Students Working Toward “Closing the Gap”

Excerpt:

Finally, the event ended after a “Call to Action” panel moderated by Roshini Epasinghe, consisting of three student pharmacists from the UCSF School of Pharmacy: Serena Huntington, Megan McCurdy and Martha Prieto. Advocates for the cause, these three student pharmacists spoke to their experiences and involvements with serving the underserved. Huntington focused on her current Schweitzer Fellowship, which is aimed at improving health outcomes through preventative medicine.

McCurdy shared her experiences in serving the underserved internationally in Mexico this past summer, where she was able to shadow physicians and learn Spanish for a period of one month. Prieto spoke about her current involvement with telepharmacy and how her fluency in Spanish has helped her to serve the underserved Spanish-speaking populations of San Francisco.

The event concluded with a brief speech given by Epasinghe, advising fellow student pharmacists on career development and matters related to networking. The sponsoring organizations hope to make “Closing the Gap” an annual event, so be sure to support them in advocating for the underserved at next year’s event.

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Telepharmacy and ePharmacy: Siamese or discrete?

There's a new paper out in the International Journal of Healthcare Technology and Management addressing Telepharmacy and e-pharmacies.

State pharmacy board meeting Wednesday in Rothschild

The Wisconsin Department of Regulation & Licensing will hold its professional pharmacy examining board meeting starting at 9 a.m. Wednesday at the Cedar Creek Lodge, 805 Creske Ave., Rothschild.

The board is part of the state’s Department of Regulation & Licensing, which licenses and regulates 128 different types of credentials in 57 professional fields, including pharmacists’ licenses. It issues nearly 50,000 new credentials and it renews approximately 350,000 credentials every two years.

“This is a great opportunity for pharmacists in central Wisconsin, other health professionals and the general public to see the work of the Pharmacy Board first hand,” said Celia Jackson, the department’s secretary. “Holding this type of meeting outside Madison is part of a broader effort to make the work of licensing and regulatory boards more visible and accessible to the people of the state.”

Agenda items include discussing various issues related to filling prescriptions as well as a closed session to deliberate on possible disciplinary actions.

Following the meeting, participants are invited to travel a short distance to Marshfield Clinic Weston Center to observe a demonstration of a remote dispensing and telepharmacy operation.

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Houston Cronicle / AP Story comments

There were a number of comments around the web on the widely mirrored Associated Press story on the North Dakota Telepharmacy Project as well as the Telemedicine project at Texas Tech University. See the previous post for that story.
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Blog Post

Telepharmacy project expands across country

ARTHUR, N.D. — The days of walking down to the general store for prescription drugs are returning to rural America, thanks to a virtual pharmacy system that has been tested on the frozen prairie.

As recently as three years ago, many elderly residents in this area of southeastern North Dakota were forced to order their medications by mail. Now, customers have a real drug store and can talk to a real person who's connected to a pharmacist by the Internet.

"It's perfect," said Jim Williams, a longtime Arthur resident. "You can walk down there and it's done in a few minutes."

North Dakota lawmakers opened the door for the telepharmacy project by passing legislation in 2001, after dozens of rural pharmacies went out of business. The project began with 10 volunteer sites in 2002 and has grown to 67 locations.

The idea may be catching on in other places.

States that have changed laws to allow for remote pharmacies include Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont and Wyoming, along with the District of Columbia. More are on the way, the head of North Dakota's project said.

"We get calls every day from other states," said Ann Rathke, director of telepharmacy at North Dakota State University in Fargo. "A lot of states have used or have adopted in some way our rules, because they were out there."

Charles Peterson, dean of pharmacy at NDSU, said the rest of the country has been "watching and waiting" to see how the North Dakota project worked.

"Every state is struggling with, the most part, the same issues," he said. "Access to health care in a rural setting is a problem for everyone. We have shown that this is a solution."

Most telepharmacies are staffed with registered pharmacy technicians, who usually need about two years of schooling and earn about $15 an hour in North Dakota. Some registered nurses also have been trained for the job.

"You don't have the expense of a regular pharmacist," said Katie E. Thompson, a registered pharmacist who lives near Page. "That's the point of a telepharmacy."

The pharmacy technicians use remote cameras to show pharmacists the original signed prescription, computer-generated label, stock bottle where the pills are stored and the bottle the patient will take home. Once the prescription is approved, patients have a mandatory private consultation with pharmacists through real-time video and audio.

"We can do most of the things the pharmacists do except give professional advice," said Jennifer Joyce, the pharmacy technician in Arthur.

She can offer guidance on other matters, such as the weather, crop conditions, family events and high school basketball. Joyce knows all of her patients on a first-name basis. Many of them are there for more than just a bottle of pills.

"When they're sick, sometimes they just want people to listen to them," she said.

Rathke said it costs about $18,000 to set up a site in North Dakota, including equipment, installation and one year of Internet service. Telepharmacies pay an annual licensing fee of $175.

"It's not rocket science, and it doesn't cost a tremendous amount of money," Rathke said.

It does take some political will, Peterson said. In most cases pharmacy has more laws and rules than any other area of health care and many states are unwilling to make modifications or adjustments, he said.

"Finally, those other states that haven't in some cases been willing to talk about it, willing to even look at it, are being forced to look at it because North Dakota has proven this thing," Peterson said.

It hasn't been proven in every state.

The first telepharmacy in Texas opened in 2002 in the town of Turkey and has gained in popularity. But only a few more sites in Texas have popped up since then, said Debbie Voyles, director of telemedicine at Texas Tech University.

"Where there are no pharmacies, there are no doctors," she said. "Patients have to travel to see the doctors, so it's no big deal to them to have to pick up the prescriptions."

The Texas Tech pharmacy school is looking at ways to increase interest and is hoping to learn from North Dakota's success, Voyles said.

Don Turner, who runs the pharmacy in Turkey, said his clients are mostly elderly people who don't have access to transportation. The nearest pharmacist to the town of 400 people is about 50 miles away.

"It's a great thing for Turkey," Turner said. "I think it's just a matter of time for other small towns."

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Automated drug dispensers become more popular in Fargo-Moorhead

FARGO – A screaming child with a late-night earache will make any parent’s skin crawl.

Not only may the pain trigger a trip to the emergency room, but the chances of getting needed medications before morning are often nil.

The InstyMeds machine at Innovis Health in Fargo dispenses prescription medicine much like a vending machine. (David Samson/The Forum)

Hospitals can’t stop ear infections, but several are addressing the prescription problem by installing ATM-style machines that dispense drugs.

These InstyMeds systems hold dozens of commonly prescribed medications, giving patients access to drugs after retail pharmacies close or saving them another trip when they’re not feeling well.

“For us, it was really about offering our patients the convenience factor,” says Todd Forktel, an administrator at Innovis Health. The Fargo hospital installed its system in April.

InstyMeds works much like an ATM machine, automatic car wash or any other type of automated kiosk.

A physician sends the prescription to InstyMeds via a computer. The patient receives a code that he or she punches into the machine to retrieve the medication, which is labeled and comes with instructions.

The system bills the patient’s insurance. Co-pays are accepted via credit card, debit card or cash. If problems or questions arise, patients can use an attached phone to reach an InstyMeds pharmacist.

“They’re so easy to use,” says Natalie Rund, emergency department nurse manager at Lake Region Healthcare in Fergus Falls, Minn. “I tell patients, if they can use an ATM machine, they can use this.”

Each hospital determines which drugs the machine will dispense. Limited supplies of antibiotics, anti-nausea drugs and pain relievers are among the most common.

InstyMeds doesn’t allow refills and most hospitals avoid filling it with medications designed for chronic conditions like high blood pressure.

“We’re not trying to compete with the pharmacists,” says Chris Harff, CEO at MeritCare Thief River Falls, Minn. “We just want to help patients who like the convenience.”

The technology fills a gap in communities that don’t have pharmacists ready to fill prescriptions 24 hours a day, seven days a week. For example, there’s no retail pharmacy open in the Fargo-Moorhead area after 10 p.m., Forktel says.

MeritCare in Fargo has a pharmacy open all the time for its emergency room patients, but not for the general public, says spokeswoman Carrie Haug.

MeritCare Thief River Falls installed its InstyMeds machine several years ago, Harff says.

“Patients love it,” she says. “If you’re sick enough to go to the emergency room, you don’t want to hang out at the pharmacy. They’re done when they leave here.”

Not everybody is fond of the technology. The North Dakota Board of Pharmacy discourages the use of dispensing machines like InstyMeds, says Howard Anderson, its executive director.

“Research has shown that the best scenario is for a patient to get information and counseling from a pharmacist,” he says. “We recommend physicians give the patient a starter supply of drugs and a prescription so a pharmacist reviews it as soon as possible.”

North Dakota has a telepharmacy program that allows patients to consult with a pharmacist even if one isn’t in the community, Anderson says.

“We’re not telling physicians they can’t dispense medications, but we’d prefer they look at this (telepharmacy) model,” he says.

Emergency rooms and urgent cares with automated dispensers still allow patients to get their prescriptions filled at a pharmacy. But patients who are comfortable getting cash from ATMs and checking in on airline flights via computer terminals have few qualms about doing the same for their prescriptions.

“In the evenings, everyone’s wondering how they’ll get medications,” says Dr. John Baugh, who works in the emergency room at Innovis Health.

Physicians, too, wonder if they’re giving patients enough drugs to last until they can get to a pharmacy, he says.

The popularity of InstyMeds has increased since Innovis installed its system in April. The first month, it dispensed 249 prescriptions. During three weeks in July, it dispensed 418 before running out of medications.

Baugh say, “Most patients seem to want to use it so they can get their medications and go home.”

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Dialing Up Medication Safety

When Lewistown (Pa.) Hospital decided to implement an electronic medication administration record, hospital executives decided patient safety was also going to get an upgrade.

The 139-bed hospital's in-house pharmacy was only open 14 hours a day. During that time an on-staff pharmacist would review all new prescription orders. Drug orders placed during off hours, however, would be reviewed and filled by nurses, who are well-versed in potential adverse drug interactions but lack the in-depth knowledge of pharmacists, says Richard Stomackin, director of the inpatient pharmacy at Lewistown.

So when the hospital deployed the electronic medication record, Stomackin also wanted to have 24-hour pharmacist review of drug orders. His first inclination was to hire two new pharmacists, but considering each position would require a six-figure salary plus benefits, finding two new staff members wasn't an attractive financial option. He also thought it would be difficult to attract qualified candidates to Lewistown's central Pennsylvania location.

Stomackin found another option in Rxe-source, a telepharmacy service from Cardinal Health, Dublin, Ohio. The telepharmacy enables a hospital to supplement its onsite pharmacy services by connecting to telepharmacists working at remote locations.

The telepharmacists receive faxed or phone drug orders, then evaluate a patient's medication profile, review necessary lab values, enter the medication into the patient profile, check for possible interactions and authorize orders for administration.

Lewistown began using Rxe-source in September 2005. The hospital's on-site pharmacy is staffed from 7 a.m. to 9 p.m. weekdays and 8 a.m. to 6 p.m. on weekends. When the on-site pharmacists leave, all calls and faxes are routed to the telepharmacy in Ohio.

Lewistown nurses typically fax the orders to the telepharmacy. The telepharmacists then connect via a secure Internet connection to Lewistown's medication administration record to check the patient's previous medications and medical conditions. The telepharmacist reviews the current order and calls a nurse or physician at Lewistown if any revisions are necessary.

After the telepharmacist approves the order, either via fax or phone, the nurse then retrieves the medication from cabinets that are stocked during the day with drugs the caregivers will need during the night shifts. If the medication is not available in a cart and needs to be administered immediately, a staff pharmacist is asked to come to the facility and fill the order.

Cardinal Health charges Lewistown a monthly fee based on the medication order volume during Rxe-source's hours of coverage. Lewistown declined to provide details about costs.

Initial setup of the telepharmacy was challenging, Stomackin says. Staff pharmacists had to fill out a 26-page survey that asked questions about the hospitals policies and procedures, as well as what drug substitutions the hospital allows and the facility's potential order volume. Lewistown also had to standardize order sets so the telepharmacist could follow standard protocols.

In addition, Lewistown nurses have had some run-ins with the telepharmacists, Stomackin says. "Nurses complain that the telepharmacy guys are stricter than we are," he says. "If you tell the telepharmacy this is hospital policy they adhere to it. This is different when we're here during the day when we have some flexibility to work things out."

Stomackin adds that because the pharmacists know the physicians and the personalities involved it's easier for them to make exceptions to hospital policy, whereas telepharmacists will stick to the rules.

But Stomackin believes the telepharmacy service has helped increase patient safety at Lewistown. "Any time you have an additional check you improve patient safety," he says. "It's one more safeguard to make sure that the patient is getting the right drug."

Another benefit of the service: by enabling the hospital to have 24-hour pharmacy coverage, it helped Lewistown improve its score during a recent review by the Joint Commission on Accreditation of Healthcare Organizations, Stomackin adds.

Pharmacists increasingly are in demand, and it's likely the need for telepharmacy services will increase, says Paul Johnston, senior consultant at Healthia Consulting, a Minneapolis-based health care I.T. consulting firm. The U.S. Department of Labor is predicting a shortfall of 157,000 pharmacists by 2020.

Rural areas that have chronic problems hiring full-time pharmacists are turning to telepharmacies to improve safety around the medication administration process, Johnston says.

"In an inpatient setting it's critical to have a pharmacist involved," he says. "The telepharmacist can check for harmful interaction, review current medications and perform dosage correction."

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Broadband Innovations, Part 4: The Doctor Isn't In but Can Still See You

How telehealth is changing the way America gets well.

"Broadband Innovations" is a four-part series that highlights groundbreaking broadband uses, and the people who employ the technology to preserve the past, reshape the future, and fulfill their dreams. This final story in the series focuses on residents of Washington State who receive medical and psychiatric care via video over the Internet.

Timothy Moon's 48 years have been colored by violence. At 16, he was shot. In 1989 he received his first prison sentence. Diagnosed as a manic depressive, Moon finally made a decision about a year ago to get help in dealing with all the anger inside him.

Typically, obtaining medical care would mean transporting Moon, accompanied by two guards, from his cell at Coyote Ridge Corrections Center in Connell, Washington, to a caregiver in Spokane, 100 miles away. A second option would be to have a psychiatrist drive all the way from Spokane to the penitentiary for every consultation.

However, thanks to the Northwest Telehealth network, which uses broadband to provide health care to remote locations, Moon undergoes videoconferencing sessions with his psychiatrist without ever leaving the penitentiary. And he likes it better than meeting in person.

"When I'm in a room by myself, there is less pressure. It's like talking to the camera, which works for me since I find it more difficult to talk about my problems in person," he says.

Moon initially tried confiding in his fellow inmates, but found that it did more harm than good. "You can't just express yourself to anyone. They'll interpret it as weakness and take advantage of it." Having been in a couple of fights, he now tries to stick to himself.

"But it's important to have someone to talk to," he says.

The Benefits of Telehealth

About 50 of the 620 inmates at Coyote Ridge use the network for their health-care needs. Aside from saving tax dollars and improving safety by minimizing the transport of prisoners, the system also discourages prisoners from feigning symptoms to break the monotony of prison's daily routine.

Telehealth executives Brian G. Hoot (left) and Gram McGregor, in front of a monitor showing an emergency room in one of the rural clinics they serve.

"In my experience, 50 percent of the inmates that come to the ER don't need to be here," says Gram McGregor, emergency department manager at Deaconess Medical Center in Spokane.

His ER department is another one of 65 sites throughout eastern Washington and northern Idaho that are connected to the Northwest Telehealth network by broadband speeds of up to 100 megabits per second. Besides penitentiaries, his ER provides rural hospitals and other sites with remote consultations.

McGregor maintains that the remote service is not just about saving money--it's also about improving the quality of care. "Many rural clinics are understaffed. Whether they need an expert consult, a second opinion, or emergency advice, they need to be able to access it remotely," he says.

Prison Saved My Life

Jorge Martinez had lost 145 pounds for no reason that he could pinpoint. He was always tired, but didn't suspect that something was seriously wrong. It was not until Martinez was incarcerated at Coyote Ridge for a narcotics crime that he found out that he was a diabetic.

"Prison saved my life. The way I was eating and drinking, I wouldn't have lasted long," says Martinez, who also says he has been able to turn his health around through hard work and guidance from regular consultations via the telehealth network.

By exercising, Martinez has been able to decrease his insulin dependency by more than half. Through diabetes education in a group over the network, he has also learned how to care for his body and skin. Next he hopes to have a teleconsult with a dietician to work out a meal plan.

Diane Benfield, the dietician at the Washington State Penitentiary in Walla Walla, saves 3 hours of travel per visit due to remote consultations with the inmates at Coyote Ridge. She says this setup allows her to schedule many more appointments with prisoners.

"The inmates are positive and don't seem to mind not meeting in person," she says. "I'd love to see the whole statewide system connected."

How Telehealth Works

In 2003, the TelePharmacy service also became available on the network. It enables nurses in 12 remote hospital sites to access approved prescription medicine through a secure vending machine.

Medication orders transmit via the network from rural hospitals to a pharmacist at Sacred Heart Medical Center in Spokane. The pharmacist reviews the prescription and confirms it on the computer. After swiping an identification card and typing in a password, the nurse at the remote site can take out the drug from the dispenser.

"Many rural communities may have a pharmacist who comes by twice a week, but they can't afford or aren't able to recruit someone full-time," says Fred W. Hoefler, manager of the TelePharmacy program at Sacred Heart.

Ronda Golladay has worked as a nurse for 30 years. Her current employer, the Othello Community Hospital, participates in the TelePharmacy program to provide pharmacy service 24/7. Under its guidelines, nursing staff must be monitored via videoconferencing when performing activities such as restocking the medicine dispenser.

"People are always apprehensive about letting other people watch them in a Big Brother way. We've tried to overcome that by educating them well in how to use the equipment," says Brian G. Hoots, telehealth analyst at Northwest TeleHealth.

In 2007, nearly 300,000 prescription orders went through the system, a number expected to increase as the TelePharmacy program adds two more sites.

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Via Christi to offer electronic pharmacy services

Via Christi Health System announced this week it is planning this fall to launch an electronic pharmacy program that is aimed at giving rural counties better access to medications.

Via Christi, the state's largest health care provider, says its e-Pharmacy incentive will address a statewide pharmacist shortage and bolster patient safety.

"Some Kansas counties do not have a pharmacy or pharmacists and many counties only have one pharmacist," said Jim Garrelts, director of pharmacy at the Via Christi Wichita Health Network in a statement. "This shortage of pharmacists likely contributes to a higher risk of adverse medication events, medication errors and substantial inconvenience."

Six Kansas counties presently have no pharmacist and 31 have only one pharmacist or pharmacy. According to the Pharmacy Manpower Project, by 2020, the national supply of pharmacists is likely to fall short of demand by 157,000 nationwide.

The Kansas Legislature recently earmarked money to increase enrollment in the University of Kansas School of Pharmacy, but the first graduates will not complete their schooling until 2014.

The e-Pharmacy program will utilize a remote order entry system under which licensed pharmacists, working outside of regular hours, such as evenings and overnight, will review scanned or faxed medication orders and patient records. The pharmacists then review and profile the accuracy of the order and authorize the hospital pharmacy system to dispense the drug. The licensed pharmacist also checks for allergies, drug interactions, correct dosage and the patient's pharmaceutical history before authorizing the dispensing of a medication.

The U.S. Department of Health and Human Services wants to reward doctors for successfully adopting electronic prescribing practices. It says e-Pharmacies improves the quality of care, lowers administrative costs and has the potential to eliminate thousands of medication errors every year.

The e-Pharmacy services are being developed in conjunction with hospital pharmacy leaders at Via Christi Health System medical centers and Salina Regional Health Center, which is affiliated with Via Christi. The program is set to begin October among Via Christi's network hospitals, Mercy Regional Health Center in Manhattan and in Mt. Carmel Regional Medical Center in Pittsburg and also will be offered to hospitals outside of the health system.

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Searsport prescribes to telepharmacy technology

SEARSPORT (July 24): The Board of Selectmen voted Tuesday, July 22 to proceed with a grant application that would make Searsport the first town in Maine to explore a new approach to the way pharmacies operate.

At a public hearing, selectmen discussed applying for grant money through the state Community Development Block Grant program to explore the feasibility of bringing a pharmacy into town.

Last year, Waltz Pharmacy closed its Main Street store.

Selectman Dick Desmarais said for several months he has worked on getting a drug store to Searsport, but that he was having difficulty finding a company or individual willing to make a move.

After contacting several in-state pharmacy chains and schools of pharmacy in Massachusetts and Connecticut, Desmarais said he contacted Chris Shrum with Eastern Maine Development Corporation in Bangor.

Two weeks later, Shrum pitched an idea that would bring a pharmacy into Searsport and provide technology to serve health centers in surrounding towns through a networking system of Massachusetts-based company, CBSRx.

Shrum said the firm takes on a variety of roles with regard to prescriptions. CBSRx has been instrumental in getting a profitable pharmacy into the Deer Isle-Stonington community, and has worked with a hospital in Sanford on fine-tuning its existing pharmacy.

“They make sure the hospital takes advantage of all the programs it can, and that they get as much reimbursement as possible from the insurance companies,” said Shrum.

Desmarais, Town Manager James Gillway, Economic Development Committee chairperson Dianne Smith and Shrum met with Jack Hellmann, CEO and president of CBSRx.

“The response was very, very good with them,” said Desmarais, adding it could lead to Searsport residents having a drug store “for many years to come.”

Hellmann, said Shrum, was vice president of operations for Rite Aid when it had 17 stores. Hellmann left Rite Aid 15 years ago after Rite Aid had opened about 2,500 stores.

Then he launched CBSRx.

And, said Shrum, Hellmann has been successful launching pharmacies. Part of Hellmann’s strategy is to conduct a market feasibility study in communities looking to partner with his company to ensure the store is needed.

“He’s figured out how to make it work in rural communities,” said Shrum. “… He’s never closed a pharmacy that he’s opened.”

EMDC, said Shrum, assists the town with the cost of the feasibility study in the form of the CDBG grant. Those grants, said Shrum, are part of a block of money - $12 million to $13 million - that the federal government annually sets aside for the state.

The funding is used for downtown planning, housing rehabilitation and municipal building restoration. for example, a CDBG grant was awarded to Searsport about nine years ago to assist with the cost of restoring Union Hall.

Once the board gives the go-ahead to apply for the CDBG funds, the town submits its grant application for the pharmacy feasibility study. Shrum said it takes four to six weeks to score the application, and if EMDC awards the grant, Searsport must hold another public hearing, followed by a townwide vote to accept the money.

Along with paying for the feasibility study, the funds will help plan ways of building a network of so-called satellite pharmacies.

The plan with CBSRx, said Shrum, would involve the establishment of a hub pharmacy, likely located at the former Waltz Pharmacy site, said Desmarais. That site is equipped with security systems that the state requires for businesses dealing with pharmaceuticals.

Once the hub pharmacy is established, CBSRx would assist in securing sites that could work as satellite pharmacies. The satellite sites, said Shrum, could include health-care facilities in Brooks, Lincolnville, and others under Waldo County Healthcare, Inc. umbrella.

Through that network, technology known in the industry as a "telepharmacy" would dispense medications through what Shrum likened to “candy machines” at satellite locations.

A doctor would prescribe medicine to a patient with a hand-held electronic device. That prescription would arrive at the hub in Searsport. A pharmacist at the hub would program the information for that particular prescription into the medication dispenser at a satellite location.

A physician, qualified nurse or pharmacist at the satellite location would check the prescription before giving it to the patient.

The medicine dispenser has a booth where patients can video conference with the pharmacist at the hub if they have questions about their medications.

Shrum said the nature of Searsport’s CDBG grant application would be the first of its kind in Maine in regard to its approach to how pharmacies operate.

Selectman Doug Norman asked if satellite locations could be susceptible to crime. Gillway said all sites are required to have security systems in place.

Desmarais said the upside is the town would not own the pharmacy; the board had established it did not want ownership.

Instead, Shrum said, an entity such as WCGH could serve as the owner of the pharmacy, and would contract with CBSRx. Shrum plans to meet soon with officials at Waldo County General Hospital to discuss the possibility of including the WCHI sites in the pharmacy network, and of the hospital taking ownership of the hub pharmacy.

Because of all the steps that must be taken to meet state and federal requirements, a hub pharmacy would not likely come to fruition before April, 2009.

Satellite locations would likely be online six to eight months later. The cost of one medication dispensing machine is $50,000 to $75,000, though Shrum said there was funding available to assist with those costs.

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Pharmacists sell startup business

Service provides remote oversight

Two Wichita pharmacists who created the state's first company to offer remote pharmacy services to rural hospitals have sold their business to Via Christi Health System.

Frontier Pharmacy Services, founded by Mark Gagnon and Tim Smith, uses remote-access technology to bridge the gap between rural Kansas communities and pharmacists caused by a national shortage of pharmacists.

The sale price was not disclosed.

Via Christi said it officially will launch the program this fall, first at its partner hospitals in Manhattan and Pittsburg and later to unaffiliated hospitals around the state that could use additional pharmacist oversight.

"I really see it as a way to enhance the pharmacy services we provide for patients," said Jim Garrelts, pharmacy director for the Via Christi Wichita Health Network. "It will enhance patient safety and expand the ability of our pharmacists to provide clinical services."

Via Christi officials cite studies that estimate the national supply of pharmacists is likely to fall short by 157,000 by 2020. Six Kansas counties have no pharmacists, and 31 have only one pharmacist or pharmacy.

Under the service, pharmacists review hospital medication orders over their computers for accuracy, potential drug interactions and efficacy, then enter the order electronically into a participating hospital's pharmacy system.

For the past year, Gagnon -- a pharmacist for Via Christi Regional Medical Center by day -- and Smith, who recently moved to the Kansas City area, have been servicing Coffeyville Regional Medical Center at night, but inquiries from rural communities in Kansas had started to pick up.

The partners decided to sell after concluding that Via Christi's name recognition and reach far exceeded their own.

"Via Christi already has a great outreach program and can really move this forward," said Gagnon, who will help lead the new program under Via Christi. "Via Christi can offer a lot more than we could. We were having to develop everything ourselves -- we were basically reinventing the wheel."

Garrelts said the hospital system, which had been looking into developing remote pharmacy services for a few years, also is working on a telepharmacy component that will use remote cameras in a two-way interactive system.

With that service, a pharmacist could oversee a pharmacy technician or nurse preparing prescriptions through a video system in real time. Via Christi will be working with the Kansas Board of Pharmacy to approve that service -- hopefully by Oct. 1, Garrelts said.

"As we got into talking about it, we realized (there are) many, many hospitals throughout Kansas who have very little pharmacy coverage, maybe once a week," he said. "We want to share the available pharmacists we do have to cover time at places currently not receiving optimal coverage."

The Via Christi network employs about 45 pharmacists.

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Leaders want wider broadband access

Broadband Internet access may be the answer to a shortage of health-care workers, dwindling employment opportunities and providing declining rural North Dakota school districts with teachers, state leaders say.

They want to make sure broadband, or high speed, access is available and affordable.

To promote broadband connectivity, the U.S. Chamber of Commerce, Chamber of Commerce of Fargo Moorhead and Connected Nation – a national nonprofit organization that works to expand access to and use of broadband Internet – sponsored a community forum in Fargo on Monday.

Cities, counties and schools in North Dakota have 100 percent broadband coverage through a state system, said Lisa Feldner, chief information officer for the state’s Information Technology Department.

She did not know what percentage of the general public has broadband access in the state.

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Lt. Governor Jack Dalrymple said the state needs to map its broadband accessibility.

Based on a program it conducted in Kentucky, Connected National estimates that increased broadband accessibility could mean a $264 million yearly economic impact in North Dakota, including $186 million in wages from nearly 5,800 new jobs.

The organization also estimates $1.4 million in health-care savings and $13.9 million in mileage savings.

Panelists at the forum gave examples of how broadband is shaping education, health care, agriculture and employment in rural communities.

School districts without the resources to hire teachers for foreign language or advanced math classes can offer those classes with the help of technology, Dalrymple said.

“The answers lie in connectivity and broadband and we have to pursue that aggressively because time is marching on,” he said.

A telepharmacy project allows small towns without pharmacists to continue operating with a registered pharmacy technician connected to a licensed pharmacist through video conferencing, said Ann Rathke, telepharmacy coordinator for the North Dakota State University College of Pharmacy, Nursing and Allied Sciences.

There are 57 telepharmacy sites in the state, with plans to open another 10 starting in September, she said.

An online mapping program from AgriData Inc. in Grand Forks, N.D., allows for more accurate aerial applications, said David Hagert, president and chief executive officer of AgriData.

Farmers can even purchase livestock and equipment through online auctions from the comfort of their homes, said Jeffrey Missling, North Dakota Farm Bureau executive vice president.

“You’re only an e-mail away from being able to do business with a whole new sector of consumers,” he said.

Missling and Don Morton, Microsoft Fargo site leader, said a good example of how broadband access can boost the economy is through companies like Verety.

The Oak Brook, Ill., company allows North Dakotans to take drive-through fast-food orders from all over the country from their homes.

“Broadband allows companies to be in locations where they can attract and keep the very best and brightest people,” Morton said.

Online

www.connectednation.org/economic_impact_study/index.php

- Read the Connected Nation report.

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New telecommunications grants total nearly $1 million

Governor Jim Doyle announced today that nearly $1 million in grants from Wisconsin's Universal Service Fund (USF) Telemedicine program will be awarded to several non-profit health organizations around the state.

Marshfield Clinic, in Marshfield, received $25,000 to purchase video conferencing equipment, point-of-sale systems, and pharmacy workstations to enable expanding the telepharmacy program to additional communities.

Memorial Hospital of Lafayette Co., in Darlington, received $65,900 to purchase a computed radiology system that will enable 24/7 access to radiologists for reading x-rays.

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Lobbying results in Federal funding for Telepharmacy

In an article about Pennsylvania U.S. Senator Bob Casey's federal earmarks, Centre Daily Times reports:

• INRange Systems spent more than $60,000 last year on lobbying. It received $1.6 million for a telepharmacy robotic device unit in Altoona.

ASHP Keeps Federal Government Officials In The Loop On Rural Pharmacy Issues

ASHP recently met with staff from the Health Resources and Services Administration's offices of Rural Health Policy (ORHP) and Pharmacy Affairs as part of a series of ongoing meetings about important Society initiatives to improve pharmacy practice and patient safety in rural settings.

During the meeting ASHP staff presented information on the Society's new Pharmacy Technician Initiative, which partners with state affiliates to push for standardized education, training, certification, and registration requirements for pharmacy technicians. ORHP staffers discussed opportunities for ASHP to work with state offices of rural health policy to advance Initiative.

The meeting participants also discussed ASHP's support for federal legislation that includes pharmacists in federal student loan repayment programs and the expansion of telepharmacy services in practice settings.

ASHP will explore ideas for research ORHP can conduct on topics such as access to pharmacy services in rural healthcare settings.

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Wisconsin Creates Remote-Dispensing Law to Ease Pharmacist Shortage

BETHESDA, MD, 15 May 2008 — As some states struggle with pharmacist shortages, the problem can be especially difficult to resolve for isolated, rural areas.

Wisconsin has created a new law this year aimed at bringing pharmacy services to remote stretches of the state through the practice of remote dispensing.

"The intent here is that pharmacy service can be increased to underserved areas, which right now may be suffering from pharmacy shortage," said Bill Black, legal counsel for the Wisconsin Pharmacy Examining Board.

The details of the law have yet to be written. The pharmacy board will examine a series of pilot programs over the next two years. Specific regulations for the law will be based on the procedures developed during the test programs, Black said.

Parts of northern Wisconsin—and even some urban areas—have little access to pharmacy services. In some cases, the entire health care system consists of a clinic with a physician and a nurse.

Currently, Wisconsin law allows physicians to prescribe and dispense drugs in underserved areas.

"This just provides an additional potential business model instead of a physician-dispensing model," Black said.

A drawback of the physician-dispensing system is that pharmacy-related paperwork can reduce the time available for patients.

"A lot of medical clinics and doctors want to be spending time seeing patients and not necessarily devoting staff time to record keeping as part of the dispensing process," he explained.

The Marshfield Clinic, which has more than 700 physicians, is among the organizations that pushed for a new way to dispense drugs in Wisconsin. The rural health care provider has 43 sites scattered across 40,000 square miles of northern Wisconsin.

"The Marshfield Clinic was very interested in embracing remote supervision of dispensing," said Gary Plank, system director of pharmacy services for the clinic.

The town of Mercer, which sits in northern Wisconsin near Michigan's Upper Peninsula, is a location that could benefit from the new remote dispensing law. In the past few years, the town lost its only community pharmacy after the local pharmacist-owner retired and could not find a buyer, Plank said.

A single clinic, staffed by a physician and a nurse practitioner, served the basic medical needs of the town and surrounding area. The town approached the Marshfield Clinic for help in providing pharmacy services for residents unable to travel to another town that has a pharmacy, Plank said.

Up to 30% of prescriptions go unfilled in some areas, Plank said, often due to the lack of convenient access to a pharmacy. The law should help those patients who may be going without needed drugs due to lack of transportation or rising gas prices.

"We have to be able to remove the barriers to getting" drugs, he said.

Black said technological advances have opened new doors for pharmacies in recent years.

"Through the use of new technology, it is much more possible do a lot of the dispensing functions at a distance," Black said.

Plank said the Marshfield Clinic did some early remote pharmacy work starting in 2003, when pharmacists oversaw the remote creation of antineoplastic drugs at three locations. Now, the group is moving ahead with a wider array of remote services.

Under the Marshfield Clinic's plan, each outlying clinic that participates would include a pharmacy technician with a computer in an examination room stocked with drugs. Video equipment linked to the Internet would connect a pharmacist with the remote technician, he said.

The technician would pull the drugs, create the product label, and enter information into the pharmacy computer system. The pharmacist would view the label, the original prescription, and the contents to approve the transaction.

Patients would then come into the room and communicate with the pharmacist over the video link.

"[A] good feature about this is that the pharmacist will be required to counsel patients regarding their medication before the medication is ultimately dispensed to the patient," Black noted.

An important factor for the Wisconsin Pharmacy Examining Board will be the final stages of the remote dispensing process. There must be security and accountability with the pharmacy technician as he or she finalizes the packaging and the labeling for dispensing, Black said.

"The goal is that the patient will have essentially the same safeguards and protocols applied to them as would happen if they would go to a pharmacy," he said.

Black said the law will help more than Wisconsin's rural residents. There will be opportunities for new partnerships between hospitals with 24-hour pharmacies and those pharmacies operating during limited hours.

"These new rules will also allow partnerships to be formed with other pharmacies that want to pick up some of that work," Black said.

Aurora Health Care, a provider serving southeastern Wisconsin, joined Marshfield Clinic in pushing for the new legislation. The Pharmacy Society of Wisconsin also advocated for the legislative change.

Black said the Wisconsin Pharmacy Examining Board will be watching the various pilot plans for the next two years. The results of the pilot programs will determine the specific rules behind the new law, Black said.

"If it is safe," he said of a proposed plan, "we should be able to find a way to make it work."

Source

Lawmakers pass drug vending bill

by The garden Island

Posted: Sunday, May 04, 2008 - 12:17:25 am HST

The state Legislature on Tuesday unanimously passed a controversial bill that will allow pharmacists to use remote dispensing machines to help low income residents in rural areas improve their access to prescription drugs.

Senate Bill 2459 evolved through a mixed batch of criticism, including pages of testimony from several Kaua‘i pharmacists.

“It was contentious at times,” state Sen. Gary Hooser, D-Kaua‘i, said Friday. “There was a lot of misunderstanding about the intent of the legislation, but I’m confident that we’ve provided a good compromise.”

Kalaheo Pharmacy Manager Catherine Shimabukuro in late March testified that the bill fails to meet the guidelines of the National Association of Boards of Pharmacy.

“It is clear to me that the intention of the Legislature is to provide prescription care to those who are without insurance,” she says. “This is a noble goal but misguided in its approach to a solution. There are many other avenues that can address this need and all are viable and doable without rewriting the laws that govern the practice of pharmacy.”

Among her arguments, Shimabukuro says there is ample access to pharmacies — negating the need to have remote dispensing machines.

There are some 227 permitted pharmacies in the state, which has a population of nearly 1.3 million residents, according to the state pharmacy board.

State Rep. Roland Sagum, D-16th District, said access means more than physical locations.

“The pricing of these subscription drugs is much cheaper than they can get at a pharmacy,” he said. “It’s for our people who are poor and the indigent.”

The bill, which sunsets in five years, will allow Ho‘ola Lahui Hawai‘i to resume the telepharmacy service that ended two years after it started in October 2005.

Ho‘ola Lahui, a federally qualified health center and Native Hawaiian health care system with offices in Lihu‘e, provides drugs to patients at Kaua‘i Veterans Memorial Hospital in Waimea and Samuel Mahelona Memorial Hospital in Kapa‘a.

“This is especially important for uninsured patients who would not otherwise obtain the drugs they need to improve their immediate health,” Ho‘ola Lahui Board Director Grace Kamai says in her testimony. “HLH provides these medications at a reduced cost to those who otherwise would not be able to afford these medications. The technology allows HLH to reduce costs further by having a central pharmacy location ... dispense acute medication at each clinic.”

Ho‘ola Lahui’s remote dispensing pharmacies were stopped in April 2007 after the state Board of Pharmacy clarified the rules that a pharmacist must be on-site to dispense medications from the machines, Kamai said.

This negated the need for the technology, increased the costs to dispense the necessary medications and decreased patient access to the drugs, according to David Peters, Ho‘ola Lahui chief executive.

Brian Carter, the pharmacist in charge at Lihu‘e Professional Pharmacy, questioned the health center’s motives.

“Ho‘ola Lahui has received money from the federal government to provide aid to the poor and needy people of Hawai‘i,” he said. “What Ho‘ola is doing is using the money that they have received, in good faith, to profit for themselves and put the pharmacies that have served this community for the past 50 years out of business.”

There are 10 independent pharmacies and seven chain retail pharmacies serving Kaua‘i by Carter’s count.

The state pharmacy board chair, Dr. Elwin Goo, testified in favor of the bill with amendments to track the remote dispensing pharmacies.

“The board supports the practice of remote dispensing and believes it is a technology that should be afforded to all pharmacies so that all residents of this state can be afforded easier access to prescription medications to meet their health care needs,” he says. “The board understands and sympathizes with the concerns of the legislature of the financial impact on the small independent pharmacies; however, this bill is not about financial gain or the prosperity of a business, but of the safe dispensing of prescription medications.”

Sagum said the bill is not meant to damage the business of established pharmacies.

“With our economy changing, our needy are getting bigger,” he said. “Many are having a hard time even buying groceries. We want to help them get through this transition time.”

Hooser said community health centers can dispense to very low-income people certain prescription drugs at the cheapest rate available to anyone.

Offering a hypothetical scenario, he said a patient can go to the health center where a doctor will prescribe medication and then have it filled at a remote pharmacy machine.

“It’s not like a vending machine at a shopping mall,” Hooser said. “It’s very controlled. Only certain medications are allowed to be dispensed and an off-site pharmacist does the record keeping.”

The patient will also be in contact with a technician via two-way sound and video monitoring devices, he added.

For more information, visit www.capitol.hawaii.gov.

Source