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.

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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.

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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?

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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.