Tele-pharmacy plan earns legislative OK

Can start in South Dakota, despite lawsuit potential

PIERRE - South Dakota pharmacists received final legislative clearance Monday to use pharmacy technicians to fill drug prescriptions at remote locations.

But members of the Legislature's rules-review committee raised questions about the lack of clear standards for “limited access” areas where tele-pharmacy would be allowed.

Several committee members warned that lawsuits could result if more definite criteria aren't developed.

The Legislature passed the law authorizing tele-pharmacy in 2007. The Board of Pharmacy has used the past year to develop rules for the new system.

The concept calls for pharmacists to communicate with pharmacy technicians and patients at the remote sites using audio-visual networks. Technicians would perform the physical act of filling the prescriptions.

Ron Huether, executive secretary for the Board of Pharmacy, said the rules will allow prescription services to communities where a pharmacist isn't present.

As an example, he said the Pamida pharmacy in Winner plans to operate a remote pharmacy at a medical clinic in Mission. The room will have restricted access.

Sen. Jean Hunhoff, R-Yankton, focused on what standards will be used to determine which communities have “limited” access to retail pharmacy services.

“It would be subject I guess to board member discretion,” Huether replied.

Hunhoff also noted that the rules don't specifically require service to be suspended while the audio-visual link isn't available.

Rep. Roger Hunt, R-Brandon, said he shared her concern about the ambiguity in the phrase “limited access.” He said there could be legal challenges about distance and types of drugs. He encouraged the Board of Pharmacy to develop better-defined standards.

Huether responded: “This is something we wrestled with a long time in developing rules.”

He said the board doesn't want tele-pharmacy to be used to compete with existing pharmacies in a community.

Asked by Rep. David Lust, R-Rapid City, what would happen if multiple providers sought to provide tele-pharmacy services in the same community, Huether said his opinion was the board probably would allow it.

Lust said this could become a matter of dispute under the “limited access” standard.

No one testified against the proposed rules. The rules-review committee approved the rule 6-0.

“I would certainly hope this would be taken back with the questions asked,” Sen. Jim Hundstad, D-Bath, said. “This is a really new thing. This is something that isn't really defined in many places.”

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Telepharmacy reaches out to the underserved

Not so long ago, medically underserved rural communities had only limited options, if any, when need arose for healthcare services and pharmaceutical support. That situation is finally changing, as necessity and technology converge in emerging applications of telepharmacy, the delivery of pharmaceutical care by means of telecommunications and information technologies to patients at a distance from large, usually urban tertiary healthcare centers.

Telepharmacy also provides nighttime pharmaceutical services to community hospitals. A few years ago, Sibley Memorial Hospital in Washington, DC, could not support a pharmacist to review medication orders for high-risk drugs (such as antibiotics, anticoagulants, antiplatelet agents, narrow therapeutic index drugs, and drugs with many potential interactions) during the night shift, so the hospital turned to telepharmacy. Once the service was implemented, nurses faxed new inpatient orders to clinical pharmacists and technicians, who reviewed these orders much as the hospital’s own pharmacy staff would have done during the day; the difference was that the nighttime pharmacy professionals were located at a remote site. Before administering medications, nurses waited for the pharmacists to review and confirm the orders. Pharmacy consultations and requests for drug information were also handled by telepharmacy during the night shift.

More recently, the Veterans Administration adopted telepharmacy practices in order to reduce costs and to remotely link patients as needed to centrally located pharmacies.

Another initiative, the North Dakota Telepharmacy Project, is a collaborative effort between the North Dakota Board of Pharmacy, the North Dakota Pharmacists Association, and the College of Pharmacy, Nursing, and Allied Sciences at North Dakota State University. In rural southeastern North Dakota, where initial testing of telepharmacy took place, seniors had been resorting to mail-order pharmacy. Now they have a community pharmacy, staffed by a pharmacy technician, and they use an internet connection to speak with a pharmacist located at a remote site. Under this model, a licensed pharmacist is located at a central pharmacy. Video conferencing enables the pharmacist to supervise a registered pharmacy technician at a remote pharmacy site. After preparing the prescription, the technician shows the pharmacist the original signed prescription, the computer-generated label, the stock bottle where the medication is stored, and the bottle the patient will take home. The drug is then dispensed and the patient has mandatory “face-to-face” counseling with the pharmacist by means of real-time audio and video.

To ensure the delivery of safe, high-quality pharmaceutical service and care, pharmacists provide drug utilization review, prescription verification/validation, and patient counseling. The latter 2 services are often omitted when a patient uses a mail-order or internet pharmacy. In 2001, North Dakota was the first state to pass administrative rules allowing retail pharmacies to operate remotely without requiring a pharmacist to be present. As of September 2008, North Dakota had 67 pharmacies, of which 44 were retail pharmacies and 23 were hospital pharmacies. Of these, at least 22 were central pharmacies and 36 were remote sites served by telepharmacy, according to Charles D. Peterson, PharmD, dean, professor, and principal investigator/director of the North Dakota Telepharmacy Project. The telepharmacy sites are full-service, with drug inventories that include over-the-counter drugs and other merchandise.

“Over 40,000 rural citizens have had pharmacy services restored, retained, or established through the North Dakota telepharmacy project,” said Dr. Peterson. “It has also added more than $12.5 million annually in economic development.” In addition, this project has created at least 40 to 50 new jobs.

In Anchorage, the Alaska Native Medical Center (ANMC) uses telepharmacy to improve prescription drug access and pharmacy services for rural patients whose villages are spread over 2,000 miles. The program employs an electronic medical record and prepackaged, bar-coded medication and prescription labels, as well as innovative software, videophones, and automated dispensing machines. The network began with 12 remote clinics and has since expanded. In 2006, the ANMC telepharmacy received an award for excellence in medication-use safety from the ASHP Research and Education Foundation.

As of September 2008, the states of Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont, and Wyoming, as well as Washington, DC, had changed their laws to permit establishment of remote pharmacies.

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White River Medical Center Uses Meta Pharmacy System to Support Distance Medication Dispensing

Hospital 35 miles away takes advantage of medication safety technologies

Floral Park, NY (PRWEB) January 9, 2009 -- Meta, a supplier of comprehensive medication safety information systems for the healthcare industry, announced today that White River Medical Center (WRMC), located in Batesville, AR, is using its medication information safety system to support remote automated dispensing machines at Stone County Medical Center (SCMC), located 35 miles from the White River facility. Both hospitals are part of the White River Health System.

This remote link allows WRMC pharmacists to provide remote medication order entry and real time review of medication orders for appropriateness of doses, as well as screening for medication allergies and drug-drug interactions. Although 35 miles away, SCMC functions as a virtual nursing unit of WRMC, allowing nurses at SCMC immediate access to medications in their dispensing machines. Two goals are achieved with this arrangement - orders for every patient are reviewed and verified by a pharmacist and nurses have access to medications without using an antiquated medication cart fill each day.

"Implementation of this unique technology has had a significant impact on patient care through the reduction of medication errors, adverse drug reactions and drug-drug interactions," explained Jody Smotherman, PharmD, Co-director of Pharmacy Services at White River Medical Center. "It has also produced improvements in employee and nursing job satisfaction as well as improved drug charge capture. A major unexpected benefit was realized in February of 2008 when an F-3 tornado struck Mountain View, destroyed part of SCMC and forced the closing of the pharmacy area. Without our remote order entry and automated dispensing machines, there would have been no access to medications after the storm."

"Jody's unique concept is an excellent example of how 'thinking outside the box' can overcome many of the challenges that face today's healthcare delivery systems," remarked Sal Barcia, CEO of Meta. "He conceived a way to improve medication dispensing and patient safety using the technology that was available to him. It is our understanding that WRMC and SCMC are the first hospitals in the state of Arkansas to deploy remote order entry. We are pleased that our system has been so effective in reducing medication errors and improving outcomes in the state."

About White River Health System
White River Health System is a not-for-profit, multi-facility healthcare organization serving residents of North Central Arkansas. The system includes two hospitals, numerous medical clinics, physician offices, outpatient therapy centers, long-term care facilities, two home health agencies, hospice, and a home medical equipment company. White River Health System is a major employer in the region with more than 1,300 employees. As a not-for-profit healthcare system, revenues generated over expenses are reinvested into healthcare technology, facility improvements and new clinical services.

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Health center reps on telepharmacy panel

LAWRENCE — Representatives from Greater Lawrence Family Health Center recently addressed the National Association of Community Health Center's Annual Conference on telepharmacy and how the process has been implemented in the Lawrence-based community health center.

Chief Information Officer Patrick Grotton, Director of Pharmacy Diane Gatchell and Timothy Hudd, assistant professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, attended the four-day conference in New Orleans. They sat on a panel addressing the topic, "Utilizing Telepharmacy Technology to Improve Access to Pharmaceutical Care in a Federally Qualified Health Center."

For more than a year, Greater Lawrence Family Health Center has been involved in a pilot program in Massachusetts. In conjunction with the Massachusetts Board of Pharmacy and the Massachusetts College of Pharmacy, the center has been testing telepharmacy and telemedicine technology.

The program, based at the 700 Essex St. clinic, has outgrown the telepharmacy model. However, Grotton sees the telepharmacy program as a successful model for other communities in Massachusetts.

"We're now reporting back to the Board of Pharmacy on what we learned over this year in both rollout and implementation of the telepharmacy model, in order for the state to decide on whether or not a larger program can be implemented statewide," Grotton said.

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New Tribal Pharmacies

The people of White Shield and Mandaree now have a way to get their medications without travelling far from home. Telepharmacies have opened at clinics in White Shield and Mandaree. Before they opened, people living in White Shield were forced to travel to the main clinic near New Town 60 miles away. The Twin Buttes Satellite Clinic, which opened in October, serves as the headquarters for the telepharmacy program on the Fort Berthold Indian Reservation.

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Pharmacies open in White Shield, Mandaree

WHITE SHIELD, N.D. (AP) Telepharmacies have opened at clinics in White Shield and Mandaree.

Tribal officials say residents from White Shield traveled to the main clinic near New Town for their medical appointments, prescriptions and medication refills despite the 120-miles round-trip drive.

Council representative Frank Whitecalfe says some heart patients in White Shield had to wait days for critical medication.

Twin Buttes Satellite Clinic serves as the headquarters for the telepharmacy program on the Fort Berthold Indian Reservation. It began operating in October.

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Open for business

White Shield Satellite Clinic telepharmacy opens

Article Photos

Submitted Photo
Pharmacist Donna Bieri, left, explains the telepharmacy process Wednesday to Three Affiliated Tribes member Matt Marsette, right, while Brenda Allard, White Shield pharmacy technician, looks on. The telepharmacy branch of the White Shield Satellite Clinic opened Wednesday in White Shield and will provide faster delivery of medications to patients in White Shield.

WHITE SHIELD Community members gathered at the Satellite Clinic in White Shield Wednesday to participate in the grand opening and ribbon-cutting ceremony of the clinic's new telepharmacy branch.

The White Shield Satellite Clinic is a sub-clinic of the Three Affiliated Tribes' Minne-Tohe Health Center west of New Town. Patients from the White Shield community have health care available to them primarily on Tuesday and Thursday each week, and their medications were usually filled in New Town and delivered to them later in the day or sometimes the following day by tribal Community Health representatives.

White Shield council representative Frank Whitecalfe cut the ribbon to officially open the telepharmacy operations at the field clinic with Stella Berquist, Minne-Tohe Health Center chief executive officer. Whitecalfe said the telepharmacy will alleviate the long waits and that in some instances, heart patients in White Shield had to wait days for critical medication.

Many residents from White Shield have traveled to the main clinic near New Town for their medical appointments, prescriptions and medication refills despite the 120-miles round-trip drive.

Donna Bieri, lead pharmacist for the Minne-Tohe Pharmacy Program, and Brenda Allard, a certified pharmacy technician, demonstrated the telepharmacy process following the ribbon-cutting ceremony. Allard will be the permanent pharmacy technician at White Shield.

"I am happy because we don't have to make the long trip to New Town for our medication it saves a lot of time for us here at White Shield," said Matt Marsette, a tribal elder who was the first community member to view the prescription process.

In addition to addressing the medical needs of the community, Whitecalfe said he has requested a full-time physician for the White Shield Satellite Clinic. With a full-time physician, the clinic will operate five days a week, contrast the two days a week when a doctor travels from the main clinic in New Town to attend to patient needs in White Shield. A physician is expected to start at the White Shield clinic in the near future.

Lovette Veach, with the Minne-Tohe Health Center, commended the tribal business council and all of the team members involved with the telepharmacy project for making it happen.

The next telepharmacy on Fort Berthold Reservation will open today at the Mandaree Satellite Clinic. Twin Buttes Satellite Clinic serves as the headquarters for the overall telepharmacy program on Fort Berthold and officially began operating in October.

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