Maine CAHs Receive Award for Patient Safety Solutions, Will Recommend Telepharmacy

A collaborative of Maine critical access hospitals has received the New England Rural Health Roundtable's President's Award for implementing new technology, practices and communication to improve patient safety over the course of 18 months and compiled the data:

MeHAF will support the hospitals' efforts to disseminate solutions generated by the project, including medication reconciliation, interventions related to high-alert medications, enhanced patient and staff education, and telepharmacy plans that more closely involve pharmacists in remote regions.

Here's the bulletin from GIH (Grantmakers in Health) with a bit more detail. MeHAF is the Maine Health Access Foundation, who made the announcement.

Medicare Grant Preps Idaho Clinics for Telepharmacy System

The Idaho State Office of Rural Health guided three grant applicants to some Flex Grants provided by the Medicare Rural Hospital Flexibility Program in August. Benewah Community Hospital and Harms Memorial Hospital were able to implement Electronic Medical Records while Syringa were a bit more advanced:

Syringa Hospital and Clinics ($23,392): Utilization of a telemedicine robot program to increase access to health care services; development of electronic prescribing connectivity for use of Electronic Health Records and in preparation for eventual telepharmacy. Partners: Saint Alphonsus Regional Medical Center and Irwin Drug.

Minnesota Sees Need for Telepharmacy in Rural Areas Rising in 2010

The Minnesota Society of Health System Pharmacists just released a position statement assessing the changes they feel are required, called Pharmacy Technician Education, Training and Competency. In the statement, highlight many of the roles technicians are increasingly expected to take on, and use some trends research to speculate on the "Future of Healthcare" in the state:

There will be increasing needs for pharmacists in prescription and telepharmacy to improve services to rural areas of the state.

Kansas Mulls New Draft Rules for Hospital and Retail Telepharmacy

As you know if you've been reading the blog for a while, Kansas is proposing new telepharmacy rules. The Kansas State Board of Pharmacy's September meeting minutes fills us in on their concerns and how far along they are in the process:

Hospital Telepharmacy Update – Mr. Coast presented the update and stated the regulation title has been changed to “Electronic Supervision of Medical Care Facility Pharmacy Personnel”. The draft regulations were presented for the Board’s review. The Board discussed the potential hazard of unintended consequences of telepharmacy being used to reduce pharmacy staffing, which could lead to a decrease in patient safety and quality of care; and that this should be taken into consideration as the regulations are drafted. The Board will forward questions and issues for the task force to discuss and consider. The next task force meeting will be October 26, 2009 in Wichita.

Retail Telepharmacy Regulations and Update – Mr. Coast updated the Board on the retail telepharmacy regulations. Aaron McReynolds, the owner and PIC at Lincoln County Pharmacy in Lincoln, Kansas , connected by phone to tell the Board his issues concerning the current retail telepharmacy draft regulations. He sent his suggestions to the Board several months ago and has requested the Board consider the North Dakota regulations. He requested the telepharmacy regulations allow controlled substances and questioned the feasibility of unit of use packaging. Mr. Coast asked if the Board would be open to allowing controlled substances on a site by site basis. Mr. McReynolds will participate in the next task force meeting to assist in drafting regulations that will resolve his areas of concern. Mr. Forbes needed the Board’s input concerning questions posed by the Attorney General’s Office. The Board reviewed the questions. The task force may address those questions as well as Mr. McReynolds’ issues. The task force will schedule a meeting.

The October minutes haven't been released yet.

Retail Telepharmacy Program in Washington "a big hit", Restores Pharmacy Services to Two Communities

Julie Garner of the University of Washington Alumni Magazine wrote an interesting article about the use of a central telepharmacy site in Bellevue to improve pharmacy services in the state of Washington:

Bellegrove started telepharmacies at the Mattawa Clinic and Wenatchee Valley Medical's Royal City Clinic in 2008. Here's how it works: The Bellegrove pharmacist talks with technicians and patients at the clinics through the Internet. The techs then fax prescriptions and insurance information to the pharmacist in Bellevue, who provides approval and instructions for filling the prescriptions. The technicians select from 128 prepackaged medications that are most used in community clinic settings.

According to the article, "Singer and his colleagues spent six months working out the telepharmacy concept with the state Board of Pharmacy to receive certification." The Washington State Board of Pharmacy seems very progressive, given the amount of telepharmacy news coming from the state.

Michigan Health Clinic Receives Rural Development Grant for Remote Pharmacists

Baldwin Family Health Care, which operates a number of family medical clinics in Michigan, is another recipient of the 2009 Distance Learning and Telemedicine Grants from the US Department of Agriculture:

The DLT project connects the applicant with remote pharmacists through tele-pharmacy. Off-site pharmacists will provide prescription dispensing and patient consultation to patients at Baldwin.

The total amount awarded was $52,400. With $13,875 in additional funding, the total project cost is $66,275, according to the USDA's DLT reports (or original PDF) recently released.

Missouri Hospital District receives USDA telepharmacy grant

The Scotland County Memorial Hospital District, serving Scotland and Schuyler Counties (Memphis area) in northeast Missouri received a $62,622 grant from the US Department of Agriculture, as 1 of 4 Missouri grant recipients from this year's USDA Distance Learning and Telemedicine Program:

This project will connect a hospital, two clinic and a phamacy. The primary purpose is telepharmacy. There will also be upgrades to the existing video-conferencing system which supports remote consultation.

Read the full report here (or Original PDF).

Retail Telepharmacy Rears Head in Singapore!

Watson's Personal Care Stores, the largest health care and beauty care chain store in Asia, has posted a job listing for a pharmacy technician at a Singapore location:

The successful candidate’s primary responsibility will be to provide telepharmacy services at Pharmacy stores. You will assist Pharmacists in preparing and dispensing medications to customers via Teleconferencing, as well as to assist in the maintenance of the dispensary to fulfill legal requirements.

It sounds like it's just a tech position, and they are calling patient conferencing by a pharmacist via telecommunications "telepharmacy." Still, very cool and this is the first I've heard of this in use in Asia!

South Dakota Hospital gets Huge Telepharmacy Equipment Grant

From the Rapid City Journal out of Rapid City, SD, comes this news:

Regional Health of Rapid City will receive a $386,549 federal grant to buy videoconferencing devices to link 15 sites, including rural hospitals as well as clinics, with regional medical resources at three sites in Rapid City. The grant was one of three Distance Learning and Telemedicine grants awarded in South Dakota last week by U.S. Department of Agriculture Rural Development.

Among the goals of the Regional Health project are specialty consultation, tele-dialysis and tele-pharmacy, as well as continuing medical education for providers, according to a Rural Development news release.

Telepharmacy keeps rural pharmacies open, more than half of CAHs do not have a dedicated pharmacist

The Fall issue of the Rural Monitor Newsletter examines rural pharmacies' challenges as they attempt to compete with internet sales, large pharmacy chains, and the national shortage of pharmacists. Writer Candi Helseth gives the obligatory nod to the North Dakota Telepharmacy Project, and also highlights the use of remote pharmacist services by hospitals for filling the pharmacy services void in rural hospitals:

63 percent of CAHs nationwide ... do not have full-time pharmacists on-site.
...
“It’s pretty obvious that these rural providers aren’t going to be able to find full-time pharmacists even if they can afford them,” Moore said. ”With remote pharmacy, where you can leverage a pharmacist taking care of three to five hospitals, it becomes cost effective for these small hospitals. I hope it’s an idea that takes off in more states because it offers answers for small areas where the retail pharmacist is no longer available as a back-up.”

Read the full article here.

Telepharmacy can "improve patient access to pharmaceutical care"

A new paper by Annie Y. Lam and Dave Rose called Telepharmacy services in an urban community health clinic system appeared in the Journal of American Pharmacists Association last month:

Setting: Suburban western Washington State during 2007 to 2008.

Practice description: Five network clinics without in-house pharmacies are remotely connected to a central pharmacy to provide telepharmacy services.

Results: At five network sites, 12,000 patients received 3,282 new prescriptions per month with webcam-enabled consultations, 589 monthly refill prescriptions, 2,800 pharmacist-provided refill authorizations, and 250 medication assistance referrals. Antibiotics were the most frequently dispensed medications. Pharmacists commented that webcam-enabled interviews provided better privacy and longer counseling duration. Six new staff members (one pharmacist and five pharmacy technicians) were added. Workspace and staff responsibilities were reassigned to facilitate medication prepackaging and ADDS prescription processing.

Conclusion: Expanded application of telepharmacy technology can improve patient access to pharmaceutical care beyond remote medication dispensing to include point-of-care refill authorization and medication assistance referrals. Further research to explore patient-focused services and to assess economic, humanistic, and clinical outcomes of telepharmacy services is needed.

More and more indicators are pointing to telepharmacy being a good way to improve patient care.

New Legislation Paves Way for Remote Dispensing in Ontario, Canada

The Ontario legislature passed Bill 179, which will allow remote dispensing in the province:

The new legislation will permit PCA Services Inc. of Oakville to roll out its PharmaTrust(TM) Med Centres across the province - something the company has been working towards for four years. Once the regulations are in place, it is expected that Med Centres will be deployed to service patients in medical clinics, hospitals, employer facilities, retail locations, and remote communities that cannot economically support a traditional drug store.

Check out the press release. We've covered the remote prescription dispensing machine previously here at the Telepharmacy Blog, and also this legislation when it was first being considered. Here are some promo videos and news pieces from Youtube:


http://www.youtube.com/watch?v=gU30LnS2qso




http://www.youtube.com/watch?v=J-kGuOu1GQ0

Army, Navy, VA use of Kiosks, Automated Dispensing, Telepharmacy on the Rise

Christopher Prawdzik from the latest edition of Military Medical Technology wrote a review of the newest pharmacy technologies in use at various military pharmacy facilities called "Less Time to Fill: Advances In Pharmacy Automation Cut Costs, Improve Accuracy And Leave Pharmacists With More Time For Patient Care":

For example, the Navy’s Pensacola, Fla., command has about 11 remote sites in addition to the Pensacola Naval Hospital. Using ScriptPro’s Telepharmacy system, any pharmacist on duty at any of these sites can accept a call at a station and verify that prescriptions are accurate. This includes verifying pictures of individual drugs with the actual filled prescription.

One big bonus of such systems is that instead of spending exorbitant amounts of time on what are essentially administrative or inventory matters, the technology allows pharmacists to do what they were trained to do. That includes understanding the medication needs of patients and ensuring that drug combinations, if multiple drugs are involved, do not lead to adverse interactions.

He talks about automation in use (Omnicell) at Walter Reed, unmanned kiosks where patients pick up prescriptions, and the telepharmacy system in the above quote from the article.

Establishment of Health Information Exchange Facilitates Telepharmacy Service

InformationWeek published an interesting article today about Health Information Exchanges (networks for sharing patient information between health-systems) in the United States. Marianne Kolbasuk McGee highlights a specific network, the Western Washington Rural Health Care Collaborative where by virtue of the fact that they use an Information Exchange, the hospitals are able to provide telepharmacy services to each other:

The exchange will initially provide the smaller hospitals, some of which have fewer than 25 beds and are located 35 or more miles from other healthcare providers, with telepharmacy services. Patient data, such as allergies, medications, lab results, and demographic information, is collected in a central repository, and pharmacists at one of the facilities can remotely provide assistance to other hospitals.

The article also mentions how 20 billion federal "stimulus" dollars have made it to or are destined for Healthcare IT needs of various health-systems around the US. Health Information Exchanges are one major result, and apparently provide a ready infrastructure for telepharmacy services.

Two quick Telepharmacy updates

Photo by Tammy Lawson

First, Tammy Lawson of the Times Republican reports that the US government is building a new Veterans Affairs (VA) clinic in Marshalltown, Iowa whose pharmacy will be serviced by remote pharmacists. This no doubt sprung from their other work in Iowa where they identified the program as one of their best and most efficient.

Second, an update on Comprehensive Pharmacy Services' newly acquired remote pharmacy division, now with a new name, comes from a small article buried in Memphis' Commercial Appeal online magazine:

Rx Remote Solutions

Comprehensive Pharmacy Services has renamed its newly acquired remote-order-entry division to Rx Remote Solutions.

Memphis-based CPS bought Napierville, Ill.-based RxKnights Inc. in June for an undisclosed amount.

Rx Remote Solutions employs pharmacists at a call center who answer calls from health care facilities including hospitals, nursing homes and behavioral health centers.

The pharmacists will have access to the facilities' patient files and will be able to review and approve medication orders even late at night.

It will be interesting to see how they do entering the remote pharmacy market around the US. You can bet the Telepharmacy Blog will be covering it.

Remote Order Entry constitutes "great leadership", gets hospital recognized by state hospital association

The Kansas Hospital Education and Research Foundation will recognize 5 hospitals in Kansas for innovative health care solutions tomorrow at the Kansas Hospital Association conference in Wichita, according to Josh Heck of the Witchita Business Journal. There were 2 co-winners and 3 honorable mentions:

Via Christi’s honorable mention is for its ePharmacy program to reduce medication errors.

Via Christi added to that effort Tuesday by signing the first hospital outside of its own health system as a subscriber to ePharmacy.

Hiawatha Community Hospital was added following a month-long test period. With the program, an ePharmacist reviews orders for the hospital seven days a week through a remote order entry system under which hospitals scan or fax orders.

As you can see, Via Christi (which we've been covering here) is really turning heads with their "ePharmacy" (aka Telepharmacy) program. They do remote order entry for outlying hospitals, and according to the article, just had Hiawatha Community Hospital sign on.

Ontario company attracts "dozens of countries" to its retail telepharmacy machine

Charlene Close of 680 News out of Toronto did an informative write up on Patient Care Automation Services, Inc from Oakville, ON:

Patient Care Automation Services Inc. (PCAS) is the developer of the PharmaTrust® MedCentre which is designed for use in hospitals, pharmacies, medical clinics and workplaces. About a dozen countries are already interested in the product.

It operates much like an automated bank machine - insert your paper prescription into the machine or pick up a phone, it then connects electronically via video to an actual pharmacist who can answer any questions the patient has and then sign off on the prescription before the drugs are dispensed.

The company received a $1.5-million grant from the National Research Council of Canada today that will assist in further development and marketing it across Canada, the U.S. and the UK.

This is the company the Canadian government expressed an interest in within a press release from October 13th, and was previously covered here at the Telepharmacy blog.

UPDATE 1: October 28, more press on the Telepharmacy machine: Fierce Healthcare ran this article, complete with announcements from Canadian government officials from the National Research Council and the Minister of State for Science and Technology's office about funding the project. The article also has new info about the system's use:

Currently, trials are taking place at Sunnybrook Hospital in Toronto, under the supervision of the hospital's pharmacy; there are production sites at the Albany Clinic, in Toronto, and Cambridge Memorial Hospital, in Cambridge, Ont.

The system is under evaluation as a pandemic response platform by researchers at the University Health Network and the company has also just recently received approval to deploy its system in select locations in the UK.

UPDATE 2: Nov, here is the National Research Council's official statement.

A bunch of Press Releases from companies touting telepharmacy

Media Advisory/National Research Council Canada: Government of Canada to Announce Significant Investment in Local Company That Will Benefit Health Care:

PCAS is the developer of the PharmaTrust^TM MedCentre, a telepharmacy dispensing and primary care system. The system is designed for applications in hospitals, pharmacies, medical clinics, workplaces and other locations, providing patients with convenient and safe access to prescription drugs.

Baxa Announces IntelliFlowRx™ to Become DoseEdge™ Dose Management System:

The addition of Preparation Modes earlier this year allowed the system to filter and control the dose queue so that oral dose prep, extemporaneous compounding, tele-pharmacy and TPN manual additions can be tracked in addition to IV dose preparations. DoseEdge also was expanded to support TPN processing – allowing orders to be received from the Baxa Abacus™ Order Entry Software.

Hyland honors customers at OnBase Training & Technology Conference who use the ECM software suite in new ways to get notable results:

Thrifty White Pharmacy - Maple Grove, Minnesota

Operating in five states in the northern Midwest, Thrifty White serves rural communities through 89 drugstores, as well as eight Telepharmacy Stores in communities where access to a pharmacist was not previously available.

Pharmacy Techs' education, roles increasingly expanded, now includes telepharmacy

Modern Medicine's Fred Gebhart published an article today about pharmacy technicians increasing role in running pharmacies and the expanded training and CE that is being required of them in today's (especially in health-systems) pharmacy environment:

More accreditation activity sounds good to Barbara Lacher, BS, R.Ph.Tech, associate professor and assistant director for the North Dakota State College of Science Pharmacy Technician Program. NDSC modeled its technician program based on pharmacy programs focused on professional education. "We don't train somebody to work 'just retail' or 'just hospital,' " Lacher said. "We educate techs to work in all settings, just as we educate pharmacists to work in all settings. That's why we are comfortable with technicians running telepharmacy operations where there is no pharmacist. We know that our techs aren't just trained to perform specific job functions; they're educated professionals."

The underlying cause (a major shortages of pharmacists) isn't mentioned, however, leaving technicians as the only option to run the pharmacy for many health systems, especially in rural areas. While they are increasingly well-trained and educated, patients still need the better-yet educated eye of a pharmacist making the final call on what medications are delivered, making telepharmacy a great option for communities lacking on-site pharmacists.

South Dakota hospital pilots telepharmacy program

The Lawrence County Journal fills us in with an article on the new telepharmacy pilot project in South Dakota's Lead-Deadwood Regional Hospital:

The total cost of the telepharmacy equipment was just more than $27,000 and will save more than $106,500 annually. Funding was provided in part by a payout from the dissolution of the Western Plains Health Consortium, in part by the LDRH Foundation, with the remainder covered by contingency funding.

The telepharmacy unit’s home setting, which is in LDRH, has two high-resolution digital cameras: One observes the activity of the pharmacy tech. The other allows the pharmacy tech at LDRH to display the medication, the label and the physician order so the medication dispensed can be visualized in real time by the pharmacist located in Spearfish or Rapid City.

The system also allows the pharmacist and pharmacy tech to have a visual/audio conversation.

“A pharmacist does not have to be on site,” Smith said. “It saves us significant personnel expenses in pharmacy wages.”

A smaller blurb with much less info was also printed in the Prairie Business Magazine out of North Dakota.

Ontario pharmacists awarded for telepharmacy work

Bryan Meadows of the Chronicle Journal writes about Colin J. Pienaar and Maritza du Preez, a pair of pharmacists from Sioux Lookout winning an award at the Ontario Pharmacists' Association annual meeting for getting the first Community hospital joined to the Ontario Telemedicine Network:

In an interview Thursday, Pienaar said the couple was very surprised by the recognition.
“We did everything because we felt it was necessary at the time. We realize now that it was quite a lot of groundbreaking stuff – quite surprisingly.”
...
When they realized this solution only met their patients‘ needs for pharmacy care one or two days a month, Sioux Lookout Remedy‘s Rx became the first community pharmacy to join the Ontario telemedicine network. Today, a video conferencing unit allows patients to see their pharmacist daily through a live television feed, and patient information materials have been translated into Oji-Cree as has a blister medication reminder card.

Is telepharmacy an answer to Swine Flu reducing available pharmacy staff?

According to Kate Traynor writing for ASHP, the Fairview Health Services network of hospitals in Minnesota is considering allowing their pharmacists to work from home in the event they or a family member contracts the flu:

Allowing pharmacists to work off-site is another option under discussion. Knoer said the seven-hospital Fairview Health Services network that includes his medical center has some experience with remote order verification. Specifically, he said, one hospital pharmacy that operates around the clock has verified orders for a smaller hospital with limited pharmacy hours.

"The doctor would write an order, the pharmacists would verify it, and the nurse would get it out of the automated dispensing unit," Knoer said.

In theory, he said, pharmacy staff with remote computer access to the hospital could verify orders from home if schools close and workers need to stay with or near their children.

"We have talked about, in the case where we would have issues with the employees not being able to come to work, we could have employees work from home or another [Fairview] site," Knoer said.

But he cautioned that many issues remain to be discussed before remote order entry can work on a large scale at Fairview.

Yet another problem Telepharmacy can help solve!

Comprehensive Pharmacy Services acquires "remote pharmacy technology"

An online business newspaper, the Memphis Commerical Appeal covered Comprehensive's acquisition of a Remote Order Entry company that will allow remote pharmacy services for the pharmacy services giant (original press release):

Upshaw said remote order entry services are fairly new to the pharmacy landscape. Comprehensive Pharmacy began pursuing the market area in 2007.

"Over the past three or four years we've seen (remote pharmacies) gaining credibility and gaining ground," he said. "People are feeling more comfortable about them now that they see quality systems in place to address the information, sharing and (Health Insurance Portability and Accountability Act) issues."

The RxKnights acquisition follows a Comprehensive Pharmacy acquisition last year of MedManagement, the pharmacy management arm of McKesson Corp. That acquisition made Comprehensive Pharmacy the country's largest pharmacy services provider.

More details in the article and press release, both are a bit short on details about the actual program, however. Still noteworthy!

Minnesota retail telepharmacy has grand opening

The Minnesota retail pharmacy that opened a few months ago had its grand opening last week in Adrian. Julie Buntjer of the Worthington Daily Globe did a write up on the event and the pharmacy's operations:

Erpestad takes prescriptions at the Adrian telepharmacy and sends digital images of the prescription, the pill bottle and the pills to Sterling Drug in Worthington, where Hagen or a fellow pharmacist must examine each image on the computer screen and approve of the medication before it can be dispensed to the customer.

In addition to digital images, the telepharmacy utilizes web cameras, specialized computer software, voiceover Internet and a dedicated communication line. The technology also provides for one-on-one counseling between the pharmacist in Worthington and the customer in Adrian.

Kansas University to use telepharmacy in new building

Kansas University's West Campus is getting a new building that will house a pharmacy that employs telepharmacy:

A pharmacy is planned for the building, which Audus said would serve KU students, faculty and staff, so as not to compete with other pharmacies in the area. That pharmacy may use automated technology, including tele-pharmacy, he said. That’s similar to a U.S. Navy setup in San Diego where pharmacists there relay information to technicians on ships at sea, who fill the prescriptions for sailors.

The new building should open by August, 2010.

Pennsylvania Hospitals receive technology grant, hope to implement telepharmacy

The Pennsylvania Mountains Healthcare Resource Development (PMHRD) received a grant from Highmark, reports the Pittsburgh Tribune-Review in a pair of nearly identical articles. Dianne Emminger, VP of IS for ACMH Hospital commented on what they intend to use the grant for:

The funding will be used to purchase equipment and software, Emminger said.

ACMH Hospital will partner with the other hospitals and care centers to provide residents those services, which are in short supply in rural communities, Emminger said.

Emminger gave some examples of how the technology could be used.

...

Another would be tele-pharmacy where remote pharmacists would enter orders into the systems of hospitals that do not have 24-7 pharmacist

...

"The specific projects are still being evaluated for feasibility," Emminger said.

The district of hospitals already has a fiber optic network in place from a grant they received in 2008, so the infrastructure is already in place.

VA to do Remote Order Entry from smartphones?

At the Washington DC VA Medical Center, chief of staff for informatics, Dr. Divya Shroff has been ushering in the use of smartphones for a few functions around the hospital normally performed by people at computers. One thing she sees in their future is Remote Order Entry via smartphones like BlackBerrys or the iPhone. From the ComputerWorld article:

Dr. Shroff sees many of the tasks currently being performed on laptops in medical settings making their ways to smartphone platforms as well. Possible future uses for mobile applications for physician's include remote order entry, remote chart changes, and the ability to read and make notes in real-time on medical materials from anywhere, to name a few, Dr. Shroff says.
...
DCVAMC is already working on an iPhone application for patients, though Dr. Shroff didn't share specifics.

This would be an absolutely amazing and revolutionary use of mobile phone technology for use in the healthcare setting. Here's to hoping they develop the application.

Two Telepharmacy CE Presentations at NRHA

UPDATED! There will be two telepharmacy presentations that you can get CE credits for at the National Rural Health Association's "Medication Use in Rural America" conference in Kansas City, Missouri on September 10^th (Conf. Starts the 9^th). David Conejo of Red River Regional Hospital in Bonham, TX, along with Emily Alexander and Becky Harvey of Envision Telepharmacy are presenting:

A telepharmacy case study: Escaping the past and planning for the future
Patient safety, manpower shortages and cost containment help determine the best practice model when hospitals reevaluate pharmacy services. Hear a case study of a critical access hospital in rural Texas using electronic supervision of pharmacy technicians. Topics include obstacles encountered, redirection of resources, a clinical management program addressing medication patient safety goals, and expanding pharmacy services.

Next up is REACH IN (Resources to Enhance the Achievement of Community Health for Indiana)'s presentation entitled Launching your telepharmacy program: It's not about the technology which will "assess the role of community pharmacists by pharmacists and patients in Health Profession Shortage Areas."

Here's a PDF of the entire agenda. See the NRHA website for more details.

Kansas Hospital to Provide Telepharmacy Service to Rural Areas

Mt. Carmel Regional Medical Center in Pittsburg, KS is looking into delivering remote pharmacy services to rural Kansas. See this article in Pittsburg's Morning Sun newspaper:

Thanks to the telemedicine unit Moran toured Friday, that access has improved greatly over the past couple of years. Members of the Midwest Cancer Alliance demonstrated the equipment — which was purchased thanks to funding that Moran helped secure — by showing Moran a mock workup of Mt. Carmel CEO Jonathan Davis. In the demonstration, Davis and his “physician” were able to converse with a doctor over teleconference while giving the doctor information about Davis’s heart and pulse.
Davis said the technology could be used in a variety of ways, but added that it came in especially vital with cancer patients who could gain access to top-notch cancer physicians without having to travel long distances. Davis said they were currently developing ways to use pharmacy consults for areas without pharmacists as well.

Remote Review of Chemo Orders Saves Time and Money

Pharmacy Practice News highlights a new and interesting application of remote electronic supervision of pharmacy technicians via live video at Exempla Lutherin Medical Center in Denver, Colorado in their article, ASHP Coverage: Remote Camera To Check Chemotherapy Orders Saves Time and Money (free login required, or use bugmenot):

Prior to implementation of the camera, decentralized pharmacists had to go to the compounding area in the central pharmacy to verify the accuracy of the order. The new process improves efficiency by eliminating the time it takes for the pharmacists to travel to the central pharmacy. The process of traveling to the central pharmacy, waiting for other personnel and completing the check took an average of 346 seconds before the camera was put in place; that was reduced to five seconds with implementation of the camera.

Additionally, after implementing the new system, the Denver pharmacists were able to more than double the number of chemotherapy doses prepared each day, from four to nine.

Great article, it highlights all the points, including that it saves them time, money ($15,000 anually!), and helps them comply with Federal regulations (797).

More info on Adrian's telepharmacy grant

As reported here a while back, the City of Adrian, MN received partial funding for its telepharmacy project, which restored pharmacy services to the area, in the form of a grant from the Blandin Foundation. The Nobles County Review fills us in again:

The Blandin Foundation notified the city of Adrian on March 13, 2009 that Adrian had been selected for the $50,000 grant through the Sterling Drug, Inc. telepharmacy project. The city received the funds from the Blandin Foundation and forwarded the funds to Sterling Drug, Inc. for the purchase of the telepharmacy equipment.

It is good to know that grants are available for hi-tech medical projects such as retail telepharmacies. If you are having trouble initiating or restoring pharmacy services to your area, you might borrow from Kevin Norskog's example and research available grants.

US Army seeks bids for Telepharmacy maintenance in Missouri

The Office of US Army Medical Command is soliciting bids for maintaining Telepharmacy equipment for a Robotic dispensing system for the General Leonard Wood Army Hospital in Fort Leonard Wood, Missouri:

PERFORMANCE WORK STATEMENT

1. SCOPE OF WORK: Contractor shall provide all labor, supplies, tools, material, transportation, parts, and equipment to perform Preventive Maintenance (PM), Calibration/Verification/ Certification (CVC), to maintain the Telepharmacy Robotics. This includes unlimited telephonic assistance and unlimited on-site maintenance repairs. The equipment is located in the Pharmacy, General Leonard Wood Army Community Hospital (GLWACH), 126 Missouri Avenue, Fort Leonard Wood, Missouri, 65473.

They will use the lowest cost provider that meets the technical specifications. Bids are due by July 16^th.

North Dakota Company Recieves Federal Grant for Telepharmacy Research

The United States Department of Agriculture awarded a company involved in starting the North Dakota Telepharmacy Project $80,000 in grant money to research Telepharmacy, reports the Storm Center Blog out of North Dakota:

Evidence shows MTM reduces the use of unnecessary physician and hospital services by reducing adverse health events and in the end total health costs. Research under this grant will be conducted with pharmacies across North Dakota to determine a model for the delivery of MTM services to remote pharmacies.

The results of the research will be used to expand the Telepharmacy Project there.

Telepharmacy system for remote supervision of pharmacy technicians in hospital decreases likelihood of medication errors, increases safety of process

The culmination of some telepharmacy work out of Kansas, finally published, highlighted earlier by this blog! An article in the newest AJHP details an interesting usage of telepharmacy:

Summary. Telepharmacy hardware and software were acquired, and an inspection camera was placed in a biological safety cabinet to allow the pharmacy technician to take digital photographs at various stages of the chemotherapy preparation process. Once the pharmacist checks the medication vials’ agreement with the work label, the technician takes the product into the biological safety cabinet, where the appropriate patient is selected from the pending work list, a queue of patient orders sent from the pharmacy information system. The technician then scans the bar code on the vial. Assuming the bar code matches, the technician photographs the work label, vials, diluents and fluids to be used, and the syringe (before injecting the contents into the bag) along with the vial. The pharmacist views all images as a part of the final product-checking process. This process allows the pharmacist to verify that the correct quantity of medication was transferred from the primary source to a secondary container without being physically present at the time of transfer.

Conclusion. Telepharmacy and bar coding provide a means to improve the accuracy of chemotherapy preparation by decreasing the likelihood of using the incorrect product or quantity of drug. The system facilitates the reading of small product labels and removes the need for a pharmacist to handle contaminated syringes and vials when checking the final product.

Sounds promising -- and a great new method of lowering medication errors in the absence of a pharmacist, as well as costs in pharmacies, though if you've been reading this blog for a while, you know remote verification of pharmacy technician work in hospitals via telecommunications isn't entirely new.

VA hints at retail telepharmacies for rural Alaskans

In a press release issued by the senior US Senator from Alaska, Lisa Murkowski, Secretary of Veterans Affairs, Eric Shinseki, spoke at a hearing of the Senate Appropriations Veterans Affairs Subcommittee and responded to questions about the VA's future approach to delivering prescription health benefits to veterans in rural areas of the state:

Cross said the VA could help Alaska through “outreach clinics,” such as those slated for Juneau and Homer, and rural health initiatives, including telemedicine programs and prescription deliveries by mail so that veterans don’t have to visit a pharmacy.

“We have much to learn and much innovation to bring forward in regard to our veterans in Alaska and we look forward to working on that,” he said.

Considering that the VA has a good idea of what telepharmacy can offer, and the head of the VA is testifying that this is more or less what they have in mind to the Senators who are going to appropriate the money, it's a good bet it will happen.

Retail Minnesota Telepharmacy up and running

An update on the Minnesota town, Adrian who got their retail pharmacy back in the form of a Telepharmacy, serviced from another town's pharmacy:

After over a year of planning and paperwork Adrian will once again have a pharmacy on Maine Street. Sterling Drug will be opening its telepharmacy in the Government Building on Tuesday, June 2.

This comes from Krisine Kern out of the Nobles County Review. According to a PDF on their website, it looks like telepharmacy equipment provider ScriptPro supplied the equipment (pdf).

Kansas State Board of Pharmacy reviewing new telepharmacy rules for retail and hospital pharmacies

Sarah Green of the Kansas Health Institute writes about upcoming telepharmacy regulation for both retail and hospital pharmacies in the state of Kansas:

The Kansas Board of Pharmacy has new regulations addressing telepharmacies under review, said Debra Billingsley, the board’s secretary.

A task force has met for the past several years to determine what regulations would best allow the expansion of telepharmacies without hurting existing brick-and-mortar businesses.

...

The new regulations are now being reviewed by state agencies; once the Department of Administration and the Attorney General’s office approve the regulations, a public hearing will be conducted. Billingsley expects the regulations to be finalized by the end of the year.

A separate task force recently began meeting to address telepharmacy operations in hospitals.

...

Eventually, once the regulations are in place, the hospital would like to provide access to its ePharmacy system to other facilities, including the state’s critical access hospitals in rural areas, Gagnon said.

“It’s going to be a big change in language of who can do what, and where you can be located,” he said. “It’s going to expand the opportunity to do new things. It’s going to be tricky to keep up with it from a legislative standpoint, as the technology continues to grow.

Add Kansas to the list of State Boards that are willing to admit that technology can help their citizens! The KHI article also has some updates from the news from about a year ago that Via Christi Health System is using telepharmacy to service outlying facilities. Green also gives a summary and update of North Dakota's telepharmacy activities:

Today, the state has 72 telepharmacy sites, arranged in a “hub and spoke” model, that provide services to underserved communities, Peterson said, many with populations between 500 and 1,000 residents. More...

Telepharmacy reduces rural critical access hospital medication errors

Cheryl Clark gives a very informative summary of the national telepharmacy report that the Telepharmacy Blog previously posted about, in HealthLeaders Media's newly published article, Can Telepharmacy Reduce Rural Critical Access Drug Mistakes? Yes:

A pharmacist service might be shared among hospitals in the same healthcare system, or in different healthcare systems. Or hospitals may join together to contract for telepharmacy services with a commercial telepharmacy company.

Several studies have concluded that such strategies can greatly improve medication safety in rural hospitals. Nationally, there is a growing shortage of pharmacists, but nowhere is that supply as lopsided as it is in remote parts of the country.

Telepharmacy helps resolve the challenge of getting pharmacists to review orders on an as-needed urgent basis when they otherwise would have to drive 45 miles across rugged mountain roads to get to the hospital.

Later, the summary highlights a unique application of remote pharmacy practice by Envision Telepharmacy from the report:

Having a pharmacist provide long-distance supervision of pharmacy technicians at a rural hospital has not been allowed, except through a pilot project run by a commercial company, Envision Telepharmacy.

Envision provides remote order review and entry, after-hours medication provision, electronic supervision of pharmacy techs and after-hours drug information and consultation.

However, the report said, "It was to recruit hospitals into the Envision telepharmacy pilot. Many hospitals had been operating in violation of state board of pharmacy regulations, but were not being cited. For some hospitals, it was a case of not wanting to solve a problem until it became one."

Quite a few reports, as well as the ISMP recently, have been commenting on the benefits of telepharmacy for a lot of rural communities. The research that this summary came from will most likely be used to shape the Obama administration's rural health policy, as it was funded by the Office of Rural Health Policy under the U.S. Department of Health and Human Services.

Nebraska Medical Center services rural hospitals, looks to expand to Iowa and Missouri

More good news out of Nebraska, with University of Nebraska Medical Center leading the way with their telepharmacy program:

Like many small, rural hospitals, the Howard County Medical Center in St. Paul doesn’t have a staff pharmacist.
But every one of the hospital’s pharmaceutical orders is checked by a pharmacist against the patient’s medical history and other scheduled medications.
It’s the kind of perk not required by law but is a standard at larger hospitals. Now, thanks to the University of Nebraska Medical Center’s new telepharmacy program, it’s available to rural hospitals, too.
“Prior to telepharmacy, we did not have that safety net in place,” said Jennifer Galvan, the hospital’s chief nursing officer. “The doctor ordered it, and the nurse gave it.”
The telepharmacy program, in which UNMC pharmacists review and enter medication information in a computer database from their homes, is one way rural hospitals like St. Paul’s are working to bridge the gap in accessibility that has historically hampered rural health care.

They are also looking for pharmacists to work remotely from home licensed in Nebraska, and surprisingly also say, "Pharmacy licensure in Iowa and Missouri required within 120 days of employment." Very interesting. Nebraska is coming up in the telepharmacy world! See the Telepharmacy Blog's telepharmacy in Nebraska category for full coverage.

ISMP: Telepharmacy a safe answer to dangerous pending pharmacy deregulation in Texas, TSHP & ASHP call to action

An update on Texas HB1924, the dangerous pending legislation in Texas that will effectively allow a nurse to dispense drugs before a review by a pharmacist in small hospitals. Michael Cohen, the president of ISMP (Institute for Safe Medication Practices) wrote a letter to Texas state Senator Jane Nelson regarding Texas HB 1924 (see "Texas to scrap regulation?"), where he mentions telepharmacy as a valid alternative when on-site pharmacists are not available:

Hospitals that we visit that are under 100 beds have pharmacists onsite on a daily basis and often have pharmacist review of medications orders via telepharmacy during off hours. It is becoming more common to have pharmacists available on a daily or 5 days a week schedule in hospitals below 50 beds with on call coverage and remote medication order review via telepharmacy. Medications commonly used in today’s hospitals, regardless of size are highly effective but have great potential for toxicity if prescribed in error and available for use without pharmacist review. A revised standard would clearly be discriminatory as it would establish two levels of care for patients in hospitals in Texas and fail to assure patients in “rural” hospitals the basic safety standards considered essential in all other hospital patients.

There you have it, directly from the head of ISMP, "the nation’s only 501c (3) nonprofit organization devoted entirely to medication error prevention and safe medication use": Prospective drug regimen reviews by qualified pharmacists are what is safe, and using Telepharmacy to increase their availability is becoming more viable and is far better from a safety standpoint than the alternative.

UPDATE from TSHP (Texas Society of Health-System Pharmacists)'s newsletter on the matter today:

TSHP is calling upon its members to help defeat a bill that could spell the end of pharmacy practice in small and rural hospitals in Texas.

HB 1924, filed at the request of the Texas Organization of Rural and Community Hospitals (TORCH) was originally written in reaction to discussions of the Texas State Board of Pharmacy’s Task Force on Class C Regulations that indicated that some changes might be recommended in hospital pharmacy practice.

The bill would put into law TSBP regulations that are 30 years old, limiting the role of pharmacists to consultant drug use review 7 days after administration, and essentially allowing nurses to practice pharmacy in rural hospitals. It is estimated that this would have affected nearly 200 hospitals in the State.

TSHP has tried to meet with TORCH and the Texas Hospital Association to find a reasonable, middle ground for compromise. Our efforts have been rejected, and, in fact, TORCH has been successful in passing the bill out of the House of Representatives and it is now in the Senate Health and Human Services Committee, awaiting a hearing.

To make matters worse, TORCH has proposed a Senate Committee Substitute that would specifically prohibit TSBP from adopting ANY regulations that would require prospective drug use review by pharmacists in any hospital less than 100 beds, would allow a nurse and an unsupervised pharmacy technician to operate a hospital pharmacy WHENEVER A PHARMACIST IS NOT PRESENT and mandate that a pharmacist only retrospectively review drug dispensing every 7 days.

TORCH and some of its members believe that the cost of having a pharmacist prospectively review new, non-emergency medication orders outweighs the benefits to patient safety and health, even though they have been shown that such review can occur electronically and inexpensively.

Besides creating sub-standard care for patients in rural areas, the bill is a bad precedent for pharmacy and patient care in any hospital. Could this lead to our largest facilities operating with just a consultant coming by once a week, while nurses dispense and monitor patients’ drug therapy?

...

The matter is so critical that the Institute for Safe Medication Practices (ISMP) and ASHP have contacted the Senate to voice their concern over what will happen to patient care if this bill passes. For copies of their letters, see the TSHP website:

ASHP – http://www.tshp.org/ASHP1924.pdf

ISMP – http://www.tshp.org/ISMP1924.pdf

We don’t often have to ask for your help. We have a great legislative team. But against the combined lobby forces of rural hospitals and their county politicos, health-system pharmacy stands to be outgunned in this important battle.

Notice in ASHP's letter they also hint at the telepharmacy alternatives:

It is important, and in the best interest of patients, to ensure that the pharmacy practice act and its implementing regulations continue to evolve and reflect modern advances in medication therapy, technology, and the needs of the patient population.

More from the Telepharmacy Blog on Texas HB1924 as it develops.

Ontario, Canada considering retail telepharmacy legislation

Current law in the Canadian province of Ontario restricts the remote dispensation of medication, machines for which already exist and are being tested, and there are amendments to legislation in the works to allow remote dispensing. Check the Ontario College of Pharmacists' entry on the matter.

In an online article from Sault Ste. Marie, Ontario's Sault Star:

Basically, the legislation enables the private sector to install the technology to meet demand, wherever that is, because "right now in Ontario law you have to have a pharmacist physically present," Erwin said.

Two machines have been tested at Toronto's Sunnybrook Hospital since June. British Columbia is already using the technology, he said.

The "ScriptCenter" is one model that holds between 400 and 500 unique patient prescriptions that has been approved in 35 U.S. states, he said.

The rest of the article is opinions from a couple local Ontario pharmacists who seem be more concerned about losing customers to automation than they are with the vast numbers of people who need prescriptions filled in under-served or outright unserviced areas of the province, though it could be that they simply left better reasons unspoken. As the Health Minister spokesman David Caplan seems to have said, "This is just providing another option. In no way is it meant to replace pharmacists."

Nebraska legislature to define "Telepharmacy" and "Remote order entry"

Amendments in the state of Nebraska's Legislative Bill 195 (pdf):

Pharmacist remote order entry means entering an order into a computer system or drug utilization review by a pharmacist licensed to practice pharmacy in the State of Nebraska and located within the United States, pursuant to medical orders in a hospital, long-term care facility, or pharmacy licensed under the Health Care Facility Licensure Act

Telepharmacy means the provision of pharmacist care, by a pharmacist located within the United States, using telecommunications, remote order entry, or other automations and technologies to deliver care to patients or their agents who are located at sites other than where the pharmacist is located.

The bill has passed general file where it can advance out of the House.

Telepharmacy company covers hospitals overnight in 10 states, 12% of nation's hospitals use an off-site pharmacy service

Maryland telepharmacy provider MedNovations got a write up in the Maryland online Gazette.net because of it's valuable remote pharmacy services for hospitals:

‘‘It’s fairly new,” said Doug Scheckelhoff, the director of Pharmacy Practice Sections for the 30,000-member trade group. In fall 2005, the most recent data available, 12.2 percent of the nation’s hospitals used an off-site pharmacy service, he said.

Keeys, 48, called privately held MedNovations a ‘‘multimillion-dollar company,” but, citing competitors, declined to provide specifics about the company’s finances.

With 28 employees at its Laurel headquarters and a six-employee staff in Westfield, Mass., MedNovations has contracted to provide remote pharmacy services to just under 30 medical institutions in 10 states, including Laurel Regional Hospital and four other hospitals in the Washington, D.C., metropolitan area, Keeys said.

‘‘I see this being a significant model for bridging the gap that’s going to be here for a long time,” he said of a national pharmacist shortage that, as baby boomers being to retire, he expects to only worsen.

Points:

• Telepharmacy can be implemented in hospitals to reduce medication errors that would occur overnight
• 12.2% of hospitals use an off-site pharmacy service, as of 2005, (so it's probably higher now)
• Telepharmacy can be provided from a central location to a number of different states
• More people needing medical care will elevate the need for remote pharmacy services
  

Director of Institute for Rural and Community Health is Proud of University Telepharmacy program

Billy Phillips, vice president and director of the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center, writes in to the Lubbock Avalanche-Journal:

Telepharmacy currently provides pharmacy services to two small rural communities whose residents would otherwise need to travel long distances to fill their pharmacy needs.

...

I am proud to say that the outstanding health improvement programs of the F. Marie Hall Institute for Rural and Community Health and the Texas Tech University Health Sciences Center are robust and continue to make a positive difference.

Idaho to regulate hospital telepharmacy service, Texas to scrap regulation?

Idaho:
From the Idaho Statesman comes this tidbit:

The House and Welfare Committee will consider a bill allowing the regulation of institutional telepharmacy services. Upon adjournment of the House, Capitol Annex, Room 240.

Bill Details:
http://www.legislature.idaho.gov/legislation/2009/H0306.htm


Texas:
On the opposite end of the spectrum, there is a bill pending in the Texas House of Representatives, authored and introduced by Rep. Joe Heflin that will effectively end any progress made on the Telepharmacy-serving-rural-areas front, while skyrocketing the rate of medication errors.

If passed, the act would enable a licensed nurse to both supervise pharmacy technicians in their duties and dispense medication from hospital pharmacies without a pharmacist's check of any kind before the medication is administered to the patient, including an on-site OR a remote electronic check, which is more feasible and affordable than ever with the advent of telepharmacy methods. The bill would affect nearly 100 hospital pharmacies in the state.

Considering his only other item of note regarding public health was to sponsor another bill welcoming members of TORCH and the TRHA to the Capitol, one can hardly wonder who lobbied Heflin for the disastrous Texas House Bill 1924. If this downright scary video is any indication of how legislation passes in Texas, HB1924 should fly through without issue.

Bill Details:
http://www.legis.state.tx.us/BillLookup/Text.aspx?LegSess=81R&Bill=HB1924

Update (April 27, 2009):
The Texas Society of Health-System Pharmacists writes in their latest newsletter:

Meanwhile, HB 1924, which would allow nurses to practice pharmacy in rural hospitals passed second reading in the House of Representatives on Friday, April 24. The bill, developed by TORCH (Texas Organization of Rural and Community Hospitals), which represents small, rural facilities, attempts to place in law rules that the Board of Pharmacy has had on the books for nearly 30 years. It states that “a nurse . . may withdraw a drug or device from the (hospital) pharmacy in sufficient quantity to fill the order”(of a prescriber) when a pharmacist is not on duty. The bill would also place in law the (current regulatory) requirement that a consultant pharmacist review drug distribution not later than 7 days after it is withdrawn by a nurse. While the law would expire on January 1, 2012 (unless re-enacted), the bill establishes a precedent that places in law the right of someone not qualified to practice pharmacy acting in that capacity, makes more permanent a method of practice that is outdated, holds back any effort to provide remote or contemporary consultant pharmacy services from undertaking drug order review and essentially establishes a “second class” of care for patients in small and rural hospitals. It is estimated that the bill would exempt nearly 200 hospitals in Texas from having adequate pharmacy services. TSHP worked to oppose and delay the bill in the House Public Health and Calendars Committees, and plans to continue to talk with TORCH to find an acceptable compromise position or defeat the legislation.

Telepharmacies get another shot in rural Nebraska

Paul Hammel writes about a telepharmacy operation in Nebraska for the World-Herald:

Last year, the Nebraska Legislature passed a bill to allow remote dispensing of pharmaceuticals, to allow small-town hospitals that didn't have 24-hour pharmacy coverage to dispense prescription drugs.

But Cover, of the state pharmacists association, said provisions to allow telepharmacies were taken out of that law. A working group is now being formed to make another run at allowing telepharmacies, she said.

Louderback said he hopes it happens soon. He could add weekend hours at the Wausa pharmacy, and other small-town drugstores could avoid closing.

"Telepharmacies are good medicine for small towns"

Jo Dee Black writes about a local telepharmacy operation in Great Falls/Three Forks, Montana:

The VanCampens purchased Liberty Drug. Justin is a pharmacist.

They also own Railway Drug in Three Forks, which is operated as a telepharmacy, a relatively new program in Montana that allows a pharmacist to oversee a registered pharmacy technician at another site using real time video and audio technology.

"Justin steps in front of a monitor and talks to our technician in Three Forks all day long," said Keri VanCampen.

Montana's telepharmacy program was authorized by the 2005 Legislature and modeled after the one established in North Dakota in 2002. It's a tool to preserve pharmacy services in small towns, said Ann Rathke of North Dakota State University College of Pharmacy.

Fred of CPhTLink.com also shares his commentary on the story.

Telepharmacy helps move error rates 'close to zero'?

Helen Figge of the Pharmacy Informatics Section of ASHP writes in US Pharm:

A telepharmacy system has been described at the University of Kansas Hospital in which the chemotherapy preparation process in the pharmacy's sterile room is monitored by bar coding and a camera that documents key steps. The technician scans the bar code on the chemotherapy drug vial to establish a match in the patient's computerized record. Then, in the sterile prep room, the technician captures an electronic image of the vial label and filled syringe prior to injecting the dose into an IV bag. A clinical pharmacist at a remote location then verifies the identity of the drug, the dose on the pulled-back syringe, the label on the IV bag, and the patient's medication order. This telepharmacy process, an alternative to using a robot, features quality assurance steps that are expected to greatly reduce errors.
...
Given the magnitude of morbidity caused by adverse drug events, including medication errors, it is imperative that systematic approaches be taken to redesign the medication dispensing process to eliminate the potential for error. It is conceivable that the combined application of powerful computer software and pharmacy system automation, including robotics, can bring dispensing error rates down close to zero. With the introduction of monitoring methods such as telepharmacy and SORS, the potential exists to continuously monitor dispensed products for correct product and dose, which could further detect and eliminate errors.

University research group compiles rural Telepharmacy policy brief for Federal Government

The Upper Midwest Rural Health Research Center, a group from the University of Minnesota Rural Health Research Center and the University of North Dakota Center for Rural Health who focus on the quality of rural health care, prepared a policy brief for the US federal government (available here), who will likely use it to set national policy regarding telepharmacy.

The full report's summary:

Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety - Findings from this new report and policy brief describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.

The following pharmacies participated in the data collection:

Arkansas State Board of Pharmacy
Cross Ridge Community Hospital, Wynne, Arkansas
St. Bernard’s Medical Center, Jonesboro, Arkansas
Idaho State Board of Pharmacy
St. Luke’s Wood River Medical Center, Ketchum, Idaho
St. Luke’s Meridian Medical Center, Meridian, Idaho
Minnesota State Board of Pharmacy
Ely-Bloomenson Hospital, Ely, Minnesota
St. Luke’s Hospital, Duluth, Minnesota
Wheatland Memorial Hospital, Harlowton, Montana
St. Vincent’s Hospital, Billings, Montana
North Dakota State Board of Pharmacy
North Dakota State University College of Pharmacy
Heart of America Medical Center, Rugby, North Dakota
Lisbon Area Health Services, Lisbon, North Dakota
Oklahoma State Board of Pharmacy
Atoka Memorial Hospital, Atoka, Oklahoma
South Dakota State Board of Pharmacy
Lead-Deadwood Regional Hospital, Deadwood, South Dakota
Texas State Board of Pharmacy
Envision Telepharmacy, Alpine, Texas
Utah Division of Occupational and Professional Licensing
Allen Memorial Hospital, Moab, Utah
San Juan Hospital, Monticello, Utah
University of Utah
Washington State Board of Pharmacy
Sacred Heart Medical Center, Spokane, Washington
Coulee Community Hospital, Grand Coulee, Washington

Support for this report was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. 5U1CRH03717-02-00.

Rural Washington gets new telepharmacy service, allows for 24/7 pharmacist review

The rural Lake Chelan Community Hospital in the US state of Washington finds new telepharmacy service in Envision Telepharmacy, after their pharmacy director was involved in Sacred Heart Medical Center's 2006 telepharmacy program in Spokane, WA. From the article:

Nielson’s experience at LCCH began three years ago, when she worked with the TelePharmacy program at SHMC. TelePharmacy is a system that, with innovative technology, pairs larger medical institutions or specialty healthcare organizations with rural hospitals that may not have 24/7 pharmacy services. Nielson helped pilot SHMC’s program at LCCH in 2006.

At the time, LCCH purchased two automatic drug-dispensing devices. Those units, each about the size of a packing box for a washer or dryer, were connected to a fiber-optic system of technology, local healthcare workers and outside pharmacists, including Nielson, who communicated with Lake Chelan healthcare workers through video conferencing.

It was the same technology that was used at SHMC, explained Nielson, except that the patient was 165 miles away instead of nine floors up.

...
As SHMC’s program evolved and put less emphasis on its TelePharmacy program, it impacted its service to smaller hospitals like LCCH. Nielson, however, still felt drawn to continue working with rural hospitals. That desire brought her to Lake Chelan on a permanent basis.
...

Although Nielson works full-time at LCCH, she cannot be there 24/7, so she searched for a new TelePharmacy program. She found Envision-Rx, an experienced Texas-based company and developed a partnership with them. Eight pharmacists in the company now provide long-distance pharmacy services to Chelan using the technology LCCH already had in place.

“TelePharmacy bridges the gap so we have 24/7 coverage at our hospital,” explained Nielson. “Pharmacists are available at all times to works with our healthcare providers and answer clinical questions. It’s a cost-effective way to have 24-hour pharmacy services.”

Nielson’s TelePharmacy partners are located in Texas, Bellingham, Wenatchee, Blaine, Indiana and Okinawa, Japan.

In LCCH’s pharmacy department, a physician’s written prescription is scanned by nurses and entered into the computer system to access the patient’s laboratory results and other information. Nielson or one of the TelePharmacy pharmacists reviews the dosage and drug interactions and completes the order entry in the computer. After that, a nurse accesses the approved prescription in the automatic dispensing device.

Throughout the process, the pharmacist monitors the verification process and has complete auditing capabilities and access to the medical records. The pharmacist checks for allergies or adverse reactions and can advise the physician if there is a more appropriate drug currently on the market. He or she may also alert the physician that a lab test is needed to monitor the effects of the medication on the patient.

Hospital Telepharmacy Program Helps Canadian Towns Recover from the Pharmacist Shortage

This is the first mention of hospital telepharmacy in Canada! From the article:

“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.”

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.”

Older Report: Washington, DC hospital benefits from Telepharmacy service

From the paper, published in AJHP in 2002, Sibley Memorial Hospital, a 340-bed acute care facility in Washington, DC acquires telepharmacy service from MedNovations:

An alternative to the traditional 24-hour pharmacy service was discussed in September 2000 by SMH's pharmacy director and officers of the telepharmacy service firm MedNovations, Inc. The pharmacists in the department determined that the current on-call pharmacists could not prospectively review all new medication orders and handle existing duties during the day and evening shifts. Support for using the telepharmacy service was obtained from the hospital's senior administrators and the patient care services, medical staff, risk management, legal, and operations departments. Issues pertaining to patient confidentiality and pharmacy licensure were addressed in provisions of the contract between the hospital and the telepharmacy firm. The new service was approved in March 2001 by the pharmacy and therapeutics (P&T) committee.
...
The telepharmacy service emphasized avoidance of medication errors, timely resolution of gaps in clinical data necessary for proper review of new orders and of missing doses, and enforcement of hospital policies and protocols (e.g., therapeutic interchanges and drug-use restrictions). A physician-pharmacist communication form enabled the telepharmacy service to clarify problematic orders on the morning shift more efficiently. (Occasionally, such orders were not verified or approved by the telepharmacy service, and resolution was not accomplished until the morning shift.)
...
It is likely that cognitive telepharmacy services and remote order entry services will grow. Expanded use of computerization and automation will further fuel the use of telepharmacy as a supplement to onsite pharmaceutical services, especially after hours. As with other pharmacy practice innovations, issues such as pharmacoeconomics and compliance with professional standards, laws, and regulations will need to be further examined as the telepharmacy model attempts to deliver high-quality care and safety in hospitals when pharmacy departments are closed.

Grants, loans for Minnesota city telepharmacy set to bring pharmacy service back to the area

Nobles County Comissioners in Worthington, MN approved of plan to loan $25,000 to the City of Adrian, MN for installation of a telepharmacy in communication with a private pharmacy in Worthington after Adrian was awarded a $50,000 grant for broadband internet from the Blandin Foundation, and the municipality was approved for a $25,000 loan from the Worthington Regional Economic Development Corp.

Julie Buntjer of Minnesota's Worthington Daily Globe writes:

In other action, the board:

Received a request from the City of Adrian for financial assistance to help establish a telepharmacy in the Adrian Government Center.

Bruce Heitkamp, Adrian City Administrator, said the community is working with Sterling Drug of Worthington to establish a pharmacy that would allow a pharmacist to provide adequate consultation to clientele via video and teleconferencing equipment. Plans are to have a pharmacy technician on staff at the Adrian location.

“In the last year, our city council has really taken a look at health care,” said Heitkamp. When the town’s only pharmacy closed a year ago, he said it left residents scrambling for services.

“The clinic in Adrian was concerned about the ability to provide prescriptions to their clientele,” Heitkamp said.

Already the City of Adrian has been approved for a $50,000 Light Speed grant from the Blandin Foundation, and it was approved for a $25,000 loan from the Worthington Regional Economic Development Corp. Heitkamp said the city was looking to the county for another piece of financing for the project. The money would cover the estimated $100,000 cost for the telepharmacy equipment. The cost represents roughly one-fourth of the total project cost.

Commissioners voiced support for the telepharmacy and directed the county administrator to work with the WREDC and the City of Adrian to finalize the funding plan.