Details on South Dakota's LDRH Telepharmacy System

According to the Lawrence County Journal out of South Dakota, Lead-Deadwood Regional Hospital recently had an open house that shed some light on the details of their telepharmacy program. A pharmacist supervises remote technicians working at LDRH from another hospital 16 miles away:

A pharmacy tech, such as Marilyn Schwaner, can dispense medications without the physical presence of a pharmacist. LDRH is tied visually through an uplink to the Spearfish Regional Hospital pharmacy. Pharmacists there can oversee a draw of medications and can communicate with voice commands. “It’s a wonderful invention,” Schwaner said.

Smith said that in the past, there were limited hours for a pharmacist to be on site in Deadwood to distribute patient medications. Technicians such as Schwaner had a small window of time to have prescriptions ready and if something was prescribed outside of the special hours, Schwaner would have to send out for the meds to another Regional facility.

Now, Schwaner can dispense medications throughout the day, as needed. “It has increased our hours of access and reduced costs,” Smith said.

This specific implementation of telepharmacy was approved by the South Dakota Pharmacy Board in October.

Two Telepharmacy Services Operating in Minnesota Highlighted, Adrian Update (Audio & Video)

Dan Gunderson of Minnesota Public Radio has a great article with multimedia about the two telepharmacy services currently operating in Minnesota with multimedia and some great info. Click here to read the article or listen using the flash player below:

Interesting points:

The Catholic Health Initiative ePharmacy went on line in March of 2009. It now serves 16 hospitals in North Dakota and Minnesota.

Minnesota law doesn't allow telepharmacies, so each one requires an annual waiver by the state board of pharmacy. Minnesota now has nine approved telepharmacies. The board is considering possible changes in the law.
...
There were questions when the telepharmacy project started. Skeptics wondered if pharmacists would make more mistakes filling prescriptions over a video link. Rathke says North Dakota State University recently completed a four-year study which found no difference in the error rate.
...

Thrifty White currently has four telepharmacy sites in North Dakota and four in Minnesota.
Weippert said he expects continued growth in telepharmacy in the six Midwestern states Thrifty White covers.

Catholic Health Initiative's ePharmacy program services hospital pharmacies while Thrifty White services outpatient pharmacies.

Minnesota 2020 also updates us with a video they produced on the telepharmacy in Adrian, MN that Sterling Pharmacy remotely supervises:

Hong Kong Outpatient Remote Pharmacist Conferencing Coming to Retail Stores

A large store chain in Hong Kong called Mannings is getting a remote pharmacist video consultation device for outpatients to consult with a pharmacist at different Mannings stores:

Jardine Matheson Group Managing Director Anthony Nightingale visited three Mannings stores including the recently opened flagship store at the Hang Lung Centre in Causeway Bay, as part of his annual tour of the Group's Hong Kong operations.

During the visit, the Mannings senior team showed Mr Nightingale new initiatives implemented at store level and demonstrated the innovative and first-to-market 'Tele-pharmacy'.

'Tele-Pharmacy' provides shoppers with pharmaceutical advice through a teleconference system link to a pharmacist stationed at another Mannings outlet. This is designed to address the needs of the increasing number of health conscious consumers.

Montana Hospital Extends Pharmacy Service to Neighboring Town

Bozeman Deaconess's hospital in Bozeman, Montana has announced they are providing pharmacy services remotely to Bozeman Deaconess Hospital in Big Sky, Montana, about 50 miles away:

A licensed pharmacist at the central Bozeman Deaconess Pharmacy site in Bozeman supervises a registered pharmacy technician at the remote Big Sky telepharmacy site through video conferencing technology. The pharmacist communicates face-to-face in real time with both the technician and the patient through real-time audio, video, and desktop computer links.

South Dakota Hospitals Contract for Telepharmacy Services

The South Dakota Department of Health awarded 20 grants to rural hospitals for various projects last week. Among the Medication Error Reduction projects was:

DeSmet – Avera DeSmet Memorial Hospital $15,000) – mobile point-of-care computer system for the tele-pharmacy program.

I couldn't find anything about what exactly their telepharmacy program entailed so I searched the South Dakota Pharmacy Board meetings website. I still didn't find anything specific about their program, but interestingly I did find a slew of other approval requests for after-hours pharmacy services for rural hospitals:

December, 2010 Meeting:

• After Hours Remote Order Entry: Gettysburg Memorial Hospital/St Mary’s Healthcare, Pierre.

October, 2010 Meeting:

• Applications have been submitted and the following sites have been approved for after hours order entry: Pioneer Memorial Hospital, Viborg; Sanford Hospital, Webster; Sanford Vermillion Medical Center; Custer Regional Hospital; Lead-Deadwood Regional Hospital, Lead; Rapid City Regional Hospital Psychiatric/Recovery; Rapid City Regional Hospice House; Same Day Surgery Center, Rapid City; Sturgis Regional Hospital Pharmacy; Spearfish Regional Hospital Pharmacy; Spearfish Regional Surgery Center.

• A motion was made by Liebe, and seconded by Nielsen to adopt “Guidelines for Approval of Variance to Weekly Pharmacist Inspection to Remote Telepharmacy Sites” and “Remote Telepharmacy Site Visit Report” as proposed by Huether. Yes votes by Liebe and Nielsen, with Marla Hayes abstaining. Motion carried.

• Nielsen made a motion to approve the variance request submitted by James Stephens for twice monthly pharmacist visits to two telepharmacy sites in Eagle Butte and Faith. Motion seconded by Liebe. Yes votes by Liebe and Nielsen, with Marla Hayes abstaining. Motion carried.
  

June, 2010 Meeting:

• Doug Smith, Sanford Health, described plans and requested approval for Sanford Health to contract with Cardinal Health pharmacy services for after hours remote order entry in rural hospitals. Jerri Ann Haak, Sanford Mid-Dakota Medical Center provided additional comments on patient care benefits of this service. Patient medication safety will be enhanced by providing timely pharmacist review of all medication orders. Motion by Nielsen to approve this service. Seconded by Liebe. Motion carried. Huether stated that the Cardinal Health pharmacy and eight pharmacists are licensed by our board.

• Applications have been submitted and the following sites have been approved for after hours order entry: Sanford Hospital Canton-Inwood; Deuel County Memorial Hospital, Clear Lake; Sandford Mid-Dakota Medical Center, Chamberlain; Douglas County Memorial Hospital, Armour; Avera Sacred Heart Hospital, Yankton; Marshall County Hospital, Britton; St. Michael’s Hospital, Tyndall; Avera St. Luke’s Hospital, Aberdeen; Avera Queen of Peace Hospital, Mitchell; and Wagner Community Memorial Hospital, Wagner.
  

April, 2010 Meeting:

• Andrea Darr, Avera Health, requested approval for the after hours remote order entry services that will be provided at Avera McKennan to Avera DeSmet Memorial Hospital, Avera St. Benedict’s Hopsital, Avera Weskota Memorial Medical Center, Avera Hand County Memorial Hospital, Dells Area Health Center/Avera Health, Flandrea Medical Center, and Platte Community Memorial Hospital. This service will comply with the guidelines established by the Board and will be expanded to other Avera facilities in the future. Hayes moved for approval. Liebe seconded. Motion passed with a unanimous vote.

• Doug Smith, Sanford Health, reported the Sanford Health System is also planning to provide after hours remote order entry to their facilities. That service will be provided by Cardinal Health from a location in Illinois. Huether stated that the Cardinal Health pharmacy is licensed with our Board and the pharmacists who will be providing the service are in the process of obtaining licensure.

New Study: 24/7 Order Review by Telepharmacists Reduces Medication Errors

There's a new study in AJHP where pharmacists from Tinity's Mercy Medical Center in Dubuque, Iowa reviewed 58% of the orders at 7 Critical Access Hospitals starting in the Summer of 2008:

Purpose. The implementation of a telepharmacy service to provide round-the-clock medication order review by pharmacists is described.
Summary. Seven critical access hospitals (CAHs) worked collaboratively as part of a network of hospitals implementing the same electronic health record (EHR), computerized prescriber-order-entry (CPOE) system, and pharmacy information system to serve as the health information technology (HIT) backbone supporting round-the-clock medication order review by pharmacists. Collaboration permitted standardization of workflow policies and procedures. Through the HIT backbone, both onsite and remote pharmacists were given access to the medication orders, the pharmacy information system, and other patient-specific clinical data in patients' EHRs. Orders are typically reviewed within 60 minutes of when they are entered into the system. The reviewing pharmacists have remote access to the EHRs in each CAH. After completing the clinical review, the pharmacist selects the appropriate medication to dispense from the CAH's formulary. If the medication order is not made using the CPOE system, the order is scanned into a document and sent via e-mail to remote pharmacists. The pharmacist enters the necessary information into the EHR and pharmacy information system. The medication order review process from this point forward is identical to that used for medications ordered via CPOE. The new medication order is then entered into the EHR, and the CAH nurse can proceed with the order.
Conclusion. The implementation of a telepharmacy model in a multihospital health system increased access to pharmacy services, allowing for round-the-clock medication order review by pharmacists.

You can read the full text here. A few interesting details: At a charge of $4 per order (wow, that seems expensive!), "the volume of and costs for medication orders reviewed remotely varies widely among the seven CAHs, from approximately 700 orders ($2,800) to over 2300 orders ($9,200) per month." Also, for the CAHs without CPOE, nurses scanned the order sheets which were then emailed to the remote pharmacists, but "Messages are sent without leaving the internal network to which the CAHs and MMC-Dubuque belong and therefore do not require Privilege Management Infrastructure encryption."

Catholic Health Initiatives Hospitals May Soon Use Telepharmacy

Michael Rowan, the COO of a 73-hospital corporation called Catholic Health Initiatives was interviewed by Becker's Hospital Review and states that they're predicting worker shortages and will employ the use of technology such as telepharmacy to process orders at smaller/more rural facilities:

... The same could be said for trying to address workforce shortages. More and more, we're finding these small, rural pharmacies can't afford 24-hour pharmacists. Electronically, we have ability to take pharmacy orders and electronically transport them to our 800-bed facility. CHI is positioned to do that, and we believe there is more and more opportunity to lessen workforce shortages and improve quality of care by being innovative the process of caring.

ASHP Proposes Telepharmacy Access is Key to Pharmacy's Future, Presents Guide at Midyear Meeting

The American Society of Health-System Pharmacists and their Research and Education Foundation held the Pharmacy Practice Model Initiative Summit in early November in Dallas, Texas where their PPMI (Pharmacy Practice Model Initiative) emerged, which includes 200+ statements about how pharmacy practice should be steered over the years to come. Among the statements passed by vote in the Technology category were:

• Telepharmacy technology, to enable remote supervision, should be available for use in pharmacy departments.
• Telepharmacy technology that allows pharmacists to interact with patients from a remote location should be available for use in pharmacy departments.

Not a month later, ASHP had their Midyear Clinical Meeting for 2010 in Anaheim, California from December 5th - 9th where one of the presentation sessions was titled "A Hitchhiker's Guide to Telepharmacy" and was meant to fill pharmacist in about various aspects of implementing telepharmacy:

• Describe ways you can work with regulatory agencies in your state to facilitate adoption of telepharmacy regulations.
• Explain the regulatory issues and environment under which telepharmacy services may be provided.
• Identify challenges in implementing a telepharmacy program at your facility.
• Name institution-specific requirements to be used when evaluating potential telepharmacy services.

Looks like great info and includes some citations of different state's laws. Unfortunately I wasn't aware of this before hand to post about it here, but slides from the presentation are available here(PDF).

VA and IHS to Enhance Access through Development of Telepharmacy

The Department of Veterans Affairs (VA) and Indian Health Service (IHS) released a Memorandum of Understanding (PDF) that they signed to "foster an environment that brings together the strengths and expertise of each organization to actively improve the care and services provided by both." The memorandum states they will:

...enhance access through the development and implementation of new models of care using new technologies, including:
a. Tele-health services such as tele-phychiatry and tele-pharmacy.

Newfoundland Supports Local Hospital with Funds for a Chemotherapy Telepharmacy System

Yesterday Canada's Newfoundland provincial government announced they are spending $3.5 million on The Central Newfoundland Regional Health Centre in Grand Falls-Windosor as part of a project that will inject a total of $30 million over 4 years in the hospital. Part of those funds will go to:

16 dialysis machines; a dictation transcription system; a medications carousel for drug distribution; automatic drug packaging system; cardiology management system; a new ambulance; chemotherapy telepharmacy admixture system; a cataract machine; two cardiac monitors; and, 10 dialysis and lift chairs.

If anyone has any more details please leave a comment.

New Outpatient Telepharmacy to Open in South Dakota

As reported in the Aberdeen News, quoting a print-only newspaper, the Ipswitch Tribune:

As it moves into a new location, Vilas Health and Variety of Ipswich is becoming a full-service retail pharmacy...
Located in the new mall on U.S. Highway 12, the business will make use of a tele-pharmacy. An on-site technician in Ipswich, Sue Morlock, will be supervised by the pharmacy staff at Vilas Pharmacy in Eureka via a visual and audio system.

Here's a link to the (current location of the) Vilas Health and Variety pharmacy.

Free webinar from NDTP: "Redefining Healthcare through Telepharmacy"

The Great Plains Telehealth Resource & Assistance Center (TRAC) is offering a free webinar about Telepharmacy on November 18th:

On Thursday, November 18th at 12:00 noon CST, Ann Rathke, telepharmacy coordinator for the North Dakota telepharmacy project, will will discuss the role that telepharmacy can play in bending the healthcare cost curve to achieve higher quality and higher value. DON’T MISS IT, REGISTER TODAY at http://www.midwesthealthed.org/events.html?eventid=64
Intended Audience are: Pharmacists, Nurse Practitioners, Nurses, Staff Development Coordinators, Managers, Administrators. At the end of this session, participants will be able to:

• Explain the health care cost curve and its impact
• Describe telepharmacy and how it can help reduce health care costs and improve health care outcomes
• Recognize how as individuals we can support telepharmacy as a catalyst for bending the health care cost curve
  

While the webinar is free, getting the CE credits isn't and has some restrictions, but it is only a nominal $10 fee. See the original Great Plains TRAC post for more info.

New Study: Telepharmacy Results in Expanded Service Hours, Faster Order Processing, More...

A new study by Via Christi in AJHP of five hospitals in Kansas has concluded:

The implementation of telepharmacy services in a multihospital health system expanded hours of service, improved the speed of processing of physician medication orders, and increased clinical pharmacy services and cost avoidance. Surveys of health care staff found that telepharmacy services were well received.

You can view the full text of the study along with charts and graphs at MedScape:

Because pharmacists' salaries are moderately high, we were interested in determining whether the cost could be partially or fully offset by the savings associated with increased clinical interventions. At an estimated salary of $55 per hour and 30 hours of work weekly, the cost of the service would be $1,650 per week. The cost avoidance associated with the increased clinical interventions documented (881 versus 619) was $23,422 ($86,064 versus $62,642) (Table 1). Therefore, the telepharmacy service generated a saving of $21,772 for one week. If this saving were extrapolated to one year, the annualized saving would be $1,132,144.

Table 1. Clinical Pharmacy Interventions During One-Week Periods Before and After Implementation of Telepharmacy Services^a

Intervention	Before Telepharmacy		After Telepharmacy
	No. Interventions	Associated Cost Avoidance ($)	No. Interventions	Associated Cost Avoidance ($)
Chart review	59	0	98	0
Chemotherapy order review	39	4,290	30	3,300
Clarify order	318	0	378	0
Dosage adjustment	4	448	116	12,992
Change from i.v. to oral route	24	600	20	500
Teaching about medications	20	4,160	59	12,272
TPN consultation	13	1,560	17	2,040
TPN follow-up	53	1,590	41	1,230
Warfarin dosing	17	12,563	15	11,085
Warfarin follow-up	18	3,330	57	10,545
Medication history	53	34,026	50	32,100
Medication reconciliation	1	75	0	86,064
Total	619	62,642	881	0

GREAT study! Hats off to authors James Garrelts, Mark Gagnon, Charles Eisenberg, Janell Moerer, and Joe Carrithers.

USDA Visits, Blogs About Minnesota Outpatient Telepharmacy

The Daily Globe out of Worthington, Minn. writes about the USDA's state director of Rural Development, Colleen Landkammer visiting the Adrian telepharmacy with Senator's Al Franken's representative to congratulate the community and talk up telepharmacy's benefits for rural communities:

Sterling Drug pharmacist Bryan Hagen (right) explains new telepharmacy procedures to (from left) Rep. Tim Walz staff member Matthew Wohlman, USDA Rural Development director Colleen Landkammer and Sen. Al Franken representative Nate Arch during a presentation of a rual business enterprise grant Tuesday afternoon in Adrian.

Hagen said the telepharmacy project has worked well thus far.
“We understand the importance of healthcare access in rural Minnesota,” he said, adding that the telepharmacy is “just what we need” to keep service in small, rural communities. Since the Sterling Drug Telepharmacy debuted, Hagen said he has received calls from other communities interested in the concept, from Fulda to Winnebago.

The USDA also subsequently blogged about it, saying:

“The telepharmacy was a unique and cost-effective way for Adrian to provide access to the services of a local pharmacy,” said Colleen Landkamer, USDA Rural Development State Director. “City officials recognized the need for a local pharmacy to remain in town and took immediate actions to make it happen.”
...
“Sterling Drug is happy to be able to bring back pharmacy services into Adrian,” said Bryan Hagen, a pharmacist at Sterling Drug in Worthington. “The telepharmacy model is a great way to keep healthcare in smaller communities where accesses to those services are important to the communities.”

Central Order Entry Site Makes 24/7 Review Affordable for 9 North Dakota Critical Access Hospitals

In the July-August 2010 edition of the Journal of Pharmacy Technology, Charles Peterson, David Scott, Ann Rathke, Patricia Killingsworth and George Hill describe a telepharmacy model where a central site processes orders for 9 North Dakota CAHs, where 24/7 pharmacist review of medication orders was not affordable before:

Background: Smaller, critical access hospitals continue to be challenged in finding sufficient pharmacist staffing to deliver quality pharmacy services. Innovative solutions are being explored, including use of technology, to address the problem of access to pharmacy services in remote rural areas.

Objective: To describe a new telepharmacy model that is being developed in North Dakota; the model establishes a central order entry site (COE site) that provides 24-hour pharmacist staffing and telepharmacy services to rural critical access hospitals within the state.

Methods: Nine rural hospitals in North Dakota established a contractual agreement with a pharmacist-staffed COE site in Fargo to obtain pharmacist staffing and pharmacy services via telepharmacy delivery.

Results: All 9 rural hospitals receiving telepharmacy services from the Catholic Health Initiatives (CHI) COE site are critical access hospitals with 25 beds or less and an average of 6625 community population (range 470–16,010); 9986 doses filled per month (range <100–21,000);

CONCLUSIONS: A telepharmacy model that involves a COE site that provides 24-hour pharmacist staffing with pharmacists who are highly trained and skilled in use of telepharmacy technology and dedicate their full-time jobs to delivery of telepharmacy services to remote rural hospitals is an affordable means of delivering pharmacy services to these hospitals.

MedCenters: Pharmacies in a box

Here's a video from CNN's coverage of PharmaTrust's MedCentre at work in the UK and coming soon to the US: http://www.cnn.com/video/#/video/health/2010/08/22/pharmacies.in.a.box.cnn

Sorry about the lack of an embedded video post, CNN isn't allowing it.

Illinois Added to the 9+ States which Provide for Outpatient Telepharmacies, Fills Rural Pharmacy Gap

Tim Landis of Illinois' State Journal-Register writes about a new outpatient pharmacy that opened in Illinois where the owner might convert it to a telepharmacy soon thanks to new legislation in the state. Some other good tidbits result from Landis speaking to Illinois Pharmacists Association executive director Michael Patton:

Patton said telepharmacy regulations were included in a rewrite of the state’s pharmacy laws that is done every decade. Two have opened in the state since the regulations were approved in April, he said.

“It allows us to reach underserved areas, and still have it under the supervision of a licensed pharmacist,” said Patton.

...

“It’s really taking pharmacies to a new dimension,” said Patton.

The first two remote locations are in Earlville, southwest of Aurora, and Chillicothe, north of Peoria. The same “home” pharmacy operates both.

According to the U.S. Department of Health and Human Services, telepharmacies also have been authorized in Alaska, Idaho, Montana, South Dakota, Texas, Utah, Vermont, Wyoming and the District of Columbia.

Patton said most of the early remote pharmacies are in rural areas.

“It would be a remote dispensing pharmacy with a certified technician. They have high-tech communications through cameras, computers and telephones,” said Patton.

Here's the regulation as defined by Illinois:
http://law.onecle.com/illinois/225ilcs85/25.15.html
Congratulations to the two Illinois towns restoring their pharmacy services!

Landis' article doesn't list Illinois because it's about Illinois, and for some reason they don't mention North Dakota either, even though ND has established most of the standards for outpatient telepharmacy operation in the United States. I'm going to attribute this to Landis' HHS figures coming from this article on the HHS website, which mentions North Dakota as the preamble to the list, which, after being ported, leaves North Dakota out. Though there's no date on their article (Bad HHS!), it seems to be from 2008 and the origin of this list of 10 states that allow for outpatient telepharmacy programs in their laws/regulations, which many media articles use.

Telepharmacy Results in Better Care!

... when a local pharmacist is not available, of course.

Pharmacy Practice News published an article in its July 2010 issue called Does Telepharmacy Result in Better Care? (free login required, or use bugmenot). As evidence that it does, they offered up an article by Judy L. Rose, PharmD, U.S. Public Health Service captain and clinical pharmacy director for Alaska Native Medical Center. She reports that pharmacists consult with clinical patients via video teleconferencing equipment, and:

Approximately 40% of our telepharmacy interventions lead to clinical improvements in several medication management areas, including drug order clarification, dose/interval changes, drug duplication, drug therapy recommendations, start/stop medication or change in drugs. Additionally, 38.7% of the interventions led to safety improvements, including better monitoring for drug allergies, drug interactions, contraindications and improved weight-based dosing. (No pre-telepharmacy measurements were available for benchmarking, so our percentages reported reflect the absolute number of interventions divided by the number of prescriptions.)
...
Our results are clear: Telepharmacy can help remote hospitals deliver high-quality pharmaceutical care, despite staffing and resource challenges.

Here's an article published in Pharmacy Today from way back in 2005 about their program's success in improving care and reducing costs while providing comprehensive pharmacy services called Telepharmacy delivers comprehensive services in rural Alaska (PDF).

Additionally, Judy put out a study in 2007, Improved and Expanded Pharmacy Care in Rural Alaska Through Telepharmacy and Alternative Methods Demonstration Project (Original PDF) and this informative presentation for the 2008 USPHS Scientific & Training Symposium in San Diego, California (PDF):


What's blocking outpatient telepharmacies from serving the medically underserved in Ohio?

Ironically enough, it seems it is the Ohio State Board of Pharmacy.

Back on the subject of the original article mentioned in this blog post, Does Telepharmacy Result in Better Care?, Pharmacy Practice News also offers a second opinion, this one from Tim Benedict, Assistant executive director of the Ohio State Board of Pharmacy. Tim says, "Compared with Ohio, the states that allow telepharmacy are larger and more sparsely populated. The board feels telepharmacy isn’t relevant for our geography and populace."

I wonder if the populace which he acknowledges live 30 minute+ drives from pharmacies in Ohio would concur. He mentions a Pharmacist in Charge is required at every pharmacy as an obstacle, although plenty of other states still manage to have outpatient telepharmacy programs while satisfying the rule. Unless I'm reading his text incorrectly, he also implies that physicians can serve the medication needs of patients as well as pharmacists can and that pharmacy technicians are more likely to divert controlled substances than doctors. Does anyone know where to find numbers as to whether this is true?

Thankfully, he does mention:

The board has approved several off-site pharmacies to receive the new orders from the hospital and then enter into the hospital computer system to perform utilization review and either approve or reject the order. Furthermore, the board recently approved the use of a dispensing machine placed in an emergency room for use in after-hours situations. The physician creates the prescription in the hospital computer and then provides the prescription to the patient. The prescription contains a bar code. The patient takes the prescription to the machine and the machine reads the bar code and provides the drug to the patient. There is a telephone connected to the machine for patient counseling with a pharmacist. The pharmacist is located in another state.

Good news that they at least allow applications of clinical telepharmacy!

Nebraska State Board of Pharmacy to Write Telepharmacy Legislation

According to their May minutes (PDF), the Nebraska State Board of Pharmacy is about to begin drafting telepharmacy legislation:

Borcher requested help from the Department in writing proposed legislation for tele-pharmacy and also requested the Department's support of the tele-pharmacy legislation
...
Borcher mentioned that he would help with the concept papers for the proposed legislation on tele-pharmacy.

Last year, the Nebraska legislature defined Telepharmacy and Remote Order Entry officially.

ASHP finds 80% of Hospitals without 24/7 Pharmacist Coverage, Publishes RMOP Guidelines, Trumpets RMOP Providers

In the upcoming issue, Drug Topics reports on ASHP's Remote Medication Order Processing guidelines published earlier this year. From the aritlce:

I had all of 2 weeks to fill those slots. It was less expensive and faster to utilize a night pharmacy service."

Stomackin signed with Cardinal Health's Rxe-source, then one of the few national RMOP providers. He still uses the service as coverage for third shift and as a resource while Lewistown builds a computerized physician order-entry system that also requires 24-hour pharmacy support 7 days a week.

Lewistown Hospital is not unusual. The latest ASHP survey found that nearly 80% of hospitals nationwide lack pharmacy coverage at some point during a typical week. The widespread lack of 24/7 coverage combined with mandates to enhance hospital technology are fueling a surge of interest in remote pharmacy management. Community pharmacy is grappling with similar issues as telepharmacy replaces pharmacists in small-town and rural healthcare settings.

ASHP's RMOP Guidelines can be found here (PDF).

MedCentre Remote Dispensing Machine to expand further in Canada, UK, and soon, USA?

PharmaTrust issued a press release today, announcing they were enabling all Ontario Telemedicine Network members to easily install and use their MedCentre dispensing machine. As a result, they got some good press on CBC News which relayed this tidbit:

[d]iscussions are continuing with about 30 health facilities, with six to 10 showing strong interest in adopting the new technology.

In an article late last month, CBCNews asked the Canadian public, "Drug vending machines: Would you use one?" in a(n unscientific) poll, to which they for the most part, surprisingly, answered NO:

Yes: 31% (410 Votes)
No: 69% (924 Votes)

See comments for their reasoning. The article also mentions:

PharmaTrust introduced the machines in Britain this week, already has three operating in Ontario and expects to have them in five U.S. states within a few months.
...
Three of the machines are currently being tested in Ontario, two at Toronto's Sunnybrook Health Sciences Centre and one in the emergency room at Cambridge Memorial Hospital.

US Navy's Worldwide Outpatient Telepharmacy Program to be Extended to Inpatients, Army, Air Force?

An article by Kate Traynor from next month's ASHP News interviews the the Navy's telepharmacy program project manager, Lieutenant Commander Marc Young (Lt. Justin Eubanks pictured above). From the article:

"We have a lot of sites, more than the other two services, that have technicians only," Young said of the Navy. "Some of these branch clinics with these technicians are literally almost like closets. They’re very small pharmacies; they’re doing 80 prescriptions a day, in some cases, with one technician."

"It’s difficult to hire folks in those places as well to get people to move to some of our remote locations," Young said.

Through telepharmacy, the technician-run pharmacy at the remote Mountain Warfare Training Center in Bridgeport, California, has access to pharmacists at the Robert E. Bush Naval Hospital in Twentynine Palms, California, Young said.

The article also mentions the Navy is waiting on funds to determine whether they'll expand the program to their inpatient pharmacies around the world and that they're talking to the Army and Air Force as well. There are also some interesting numbers on Navy pharmacists and technicians. Great, insightful article.

New Study: Many US States Neglect Setting Any Telepharmacy Policy

In a new study in the American Journal of Health-System Pharmacy (AJHP), the "Current practices and state regulations regarding telepharmacy in rural hospitals" were examined for a good number of US states. Through a series of interviews with board of pharmacy directors, a team out of the University of Minnesota including Michelle Casey, Todd Sorensen, Walter Elias, Alana Knudson, and Walter Gregg found:

Results. Although telepharmacy is addressed in NABP’s model pharmacy practice act, many state boards are just beginning to address it. The model act addresses the practice of pharmacy across state lines, and the state board directors interviewed generally agreed that pharmacists should be licensed in the state where they are providing the service. States differed on whether a pharmacist should be required to be physically located in a licensed pharmacy and how much time the pharmacist should have to spend onsite. Telepharmacy models being implemented in hospitals in several states incorporate long-distance supervision of pharmacy technicians by pharmacists. The models being implemented vary according to area, state regulations, hospital ownership, and hospital size and medication order volume. Most hospitals reported that they track medication error rates, and some said error rates have improved since telepharmacy implementation.

Conclusion. The application of telepharmacy in rural hospitals varies across the United States but is not widespread, and many states have not defined regulations for telepharmacy in hospitals.

Arkansas: Medical Center Provides Telepharmacy for Disaster Relief, Reduces Errors

In an article in online magazine "Lifestyle" called White River Medical Center Uses Meta Pharmacy System to Support Distance Medication Dispensing, Holly Meyer of tells a tale of two medical centers in North Central Arkansas, one providing remote order entry to the other in the absence of an on-site pharmacist:

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."

Another advantage of telepharmacy: disaster relief!

North Dakota Telepharmacy Project Continues to Expand

Candie Helseth wrote an article in Prairie Business Magazine about Kathy Nelson, a North Dakota pharmacy owner who remotely supervises technicians dispensing medications in a retail setting. The NDTP's stats were highlighted a bit as well:

The use of telepharmacy technology is growing in North Dakota, which in 2001 became the first state to approve legislation allowing retail pharmacies to operate in remote areas without requiring a pharmacist to be physically present.

In the decade preceding the creation of the North Dakota Telepharmacy Project, the state had lost 26 pharmacies. As a result of the state’s telepharmacy project, 40,000 rural residents in North Dakota have had pharmacy services restored, retained or established, according to Ann Rathke, the coordinator of the state’s telepharmacy project.

Medical Centers Extend Telepharmacy to Rural Alaskans

A telepharmacy provider, Alicia Roberts Medical Center in Klawock, won the "Outstanding Rural Health Organization Award" at the Alaska Rural Health Conference in Anchorage on April 28. According to "Stories In The News" out of Ketchikan (and later Capital City Weekly), they were able to greatly expand their medical services with funding through the U.S. Health Resources and Services Administration (HRSA). Meanwhile, the Maniilaq Health Center in Kotzebue provides telepharmacy services to surrounding villages in Northwest Alaska:

Clinic Administrator Donna Miller and SEARHC Community Health Care Services Medical Director Dr. David Vastola

According to their website, "The Pharmacy staff of four clinical pharmacists and two pharmacy technicians provides pharmaceutical products and clinical pharmacy services to outpatients, inpatients, village residents, and residents of the Kotzebue Senior Citizen's Cultural Center." You wouldn't know it by just reading their site, but this US Air Force article pronounced the fact, and Freddy Kaniki confirmed it to me via email.

Dispensing Machines, Telepharmacists Fill Void Left by Closing Pharmacies

David Wahlberg of the Wicsconsin State Journal wrote a great article yesterday about the problem of vanishing pharmacies in Wisconsin, and the rise of outpatient telepharmacy programs. He explains why pharmacies are closing (mostly high costs, and mentions that pharmacists are expensive) and how telepharmacies and Dispensing Machines like InstyMeds' are taking the place of full-blown pharmacies:

InstyMeds machines

In some small towns where pharmacies have vanished, InstyMeds machines prevent patients from having to make trips to other cities.

...

About 200 InstyMeds machines are being used in 25 states, according to Minnesota-based InstyMeds. That includes 45 in Wisconsin, 34 of which are in rural clinics and hospitals.

While the machines fill a gap, an important connection is lost.

“It cuts pharmacists out of the loop, and we lose personal contact with patients,” said Mike Peterson, pharmacy director at Upland Hills.

Video connections

Pharmacists are in the loop but miles away at remote dispensing sites, which use video connections to preserve pharmacy services in some rural communities. They’re also called telepharmacy sites.

Wisconsin approved the sites two years ago, and rules on how to run them took effect this month. Sixteen states allow them, said Ann Rathke, telepharmacy coordinator in North Dakota, which in 2001 became the first state to approve the sites.

So far, four telepharmacies are operating in Wisconsin: at Marshfield Clinic centers in Mercer and Lake Hallie, near Chippewa Falls; and in Gillett and Mountain, small towns northwest of Green Bay where the clinics are owned by Community Memorial Hospital in Oconto Falls.

Pharmacy technicians work at the sites. As the tech prepares medications, a pharmacist consults from another location through a video screen. When the tech hands over the drugs to the patient, the pharmacist appears on another video screen to give instructions and answer questions.

...

But with pharmacy techs making roughly $30,000 a year, compared with about $110,000 for pharmacists, the sites allow service in rural locations that don’t have enough business to justify having a pharmacist on site. “It’s a compromise,” Wunrow said.

Definitely check out the WSJ article. There are pictures, a flash graphic and a video included as well:

Recent Telepharmacy Study Round-Up

Jayashri Sankaranarayanan published a Viewpoint in Medscape today, about a study in the Journal of the American Pharmacists Association from August 2009 called "Exploring the formation of patient satisfaction in rural community telepharmacies" that attempted to assess patient satisfaction with outpatient telepharmacies in rural communities. The study concluded:

A previous application of this instrument in a traditional community pharmacy setting yielded two interrelated latent constructs ("friendly explanation" and "managing therapy"). Our analysis suggests that the formation of patient satisfaction in rural community telepharmacies is much simpler in that patients form a single construct exhibiting high mean and median values. Anecdotal evidence from the literature suggests that the formation of a single construct reflects patients' desire to retain a point of access to health care in their communities.

Jayashri's analysis of the study is a little more straightforward:

Low response rate (24%) may have biased the study findings because highly satisfied patients may have responded to the survey and dissatisfied patients may not have responded. Study results are limited to telepharmacies in the Midwest. Because some patients may want to keep a point of access to healthcare in their communities as opposed to driving outside of the community to receive it, they may have reported high satisfaction with telepharmacies.

This is one of the first studies to evaluate patient satisfaction with telepharmacy. If patient behaviors are consistent with patient values, telepharmacy may complement the rural community pharmacy and have the potential to remain profitable while improving quality of care.

Sounds like in any case, patients were able to get the drugs they needed, which might not have been possible locally, without a telepharmacy.

Upon realizing I missed this study back Fall 2009, I looked back through PubMed for more interesting stuff I might have missed and found a couple more.

Implementing after-hours pharmacy coverage for critical access hospitals in northeast Minnesota (Sept. 2008)

CONCLUSION: Using Internet-based health IT, pharmacists from a metropolitan (hub) hospital with round-the-clock pharmacist coverage participated in the care of patients at a number of small, rural hospitals and helped ensure that those patients received safe and effective medication therapy. The coverage provided by pharmacists at the hub hospital improved nursing satisfaction with the overall quality of pharmacy services provided by both the hub hospital and the local onsite pharmacists.

Implementation of home-based medication order entry at a community hospital (Nov. 2009)

CONCLUSION: A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.

Arizona Outpatient Telepharmacy Program gets Federal Earmark

On US Congresswoman from Arizona Gabrielle Giffords' website, under 'Fiscal Year 2011 Appropriations,' she highlights several earmarks she referred to the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. One interesting item, referred to Giffords by State Rep Bradley is listed below:

Telepharmacy – Marana Health Center, Inc., 13644 North Sandario Road, Marana, AZ 85653 - $200,000, HHS-HRSA: Funding will be used to establish a telepharmacy in the MHC Primary Care Health Center at the TMC Campus to provide low-cost pharmaceuticals to uninsured and underinsured patients utilizing the 340B drug program. This service would be available to patients at six MHC satellite clinics in east and central Tucson, encompassing over 145,000 people. This is an important use of taxpayer funds because the only pharmacy services currently available in this area are commercial pharmacies, none which provide low-cost prescription drugs. Click here for a letter of support from Arizona State Representative David Bradley.

Looks like an ambulatory care telepharmacy operation is in the works in urban Arizona!

College of Pharmacists of British Columbia Propose Bylaw Changes Involving Telepharmacy Rules

Earlier this month, the BC College of Pharmacists proposed some amendments to the Bylaws of the Pharmacy Operations and Drug Scheduling Act (PODSA, which is Current law in the Canadian province of British Columbia). Among the changes (in yellow) are adjustments from "Pharmacist" to "Full Pharmacist," rules for managers of "Central pharmacy sites" and quite a few responsibility shifts. Here are the current bylaws for comparison.

Thanks to a reader for pointing this out.

NDSU Telepharmacy Update at the North Dakota Pharmacists Association Convention

The North Dakota Pharmacists Association (NDPhA) is hosting several talks at their 125th Annual Convention in April. One is an update on the North Dakota Telepharmacy Project from Shelley Johnsen and Ann Rathke, the director of the Hospital Telepharmacy Project, and Telepharmacy Coordinator at NDSU, respectively. According to the convention schedule, it's from 2 to 3 PM on Friday, April 23, 2010. Students get in free and the lectures are worth CE credits.

New Nationwide Grants Provide for Telepharmacy Service in Rural Hospitals

First up, the FCC gave out $145 million in grant money to rural health consortiums in support of upgrading their networks for things like telehealth and just general day-to-day operations. All in all, the grants affect more than 2000 rural hospitals around the US. The press release, Rural Telemedicine Program Funds 16 More Broadband Telehealth Networks, states at least one health network will use the cash explicitly for a telepharmacy system between 12 hospitals:

Pennsylvania Mountains Healthcare Alliance ($4.49 M) – A new broadband network of approximately 12 hospitals in rural western Pennsylvania will provide a variety of telehealth services, specialty care, and telepharmacy in 18 counties. The network will provide a minimum of 10 Mbps service and connect with Internet2. The project previously merged with the Juniata Valley Network project, a network in the rural region of the Appalachian Mountains that will connect approximately 79 health care facilities to enable telemedicine and school wellness programs, and will connect to Internet2 at speeds ranging from 7 to 100 Mbps.

Additionally, this "Flex Update" from the University of North Dakota's Center for Rural Health has a section called Impacts of the 2009-2010 SHIP Grant Awards where they detail how Small Rural Hospital Improvement Program grants from the federal Office of Rural Health Policy were spent at Critical Access Hospitals around the state. North Dakota CAHs received a total of $271,250, of which, 69% were purchases for computers, software, servers and the like. Last years grants allowed CAHs to implement Electronic Medical Records. Some of this money will undoubtedly go to telepharmacy projects.

PharmaTrust's Dispensing Machine Headed to the UK

PharmaTrust's MedCentre remote consultation and dispensing machine is likely headed to the UK, they've announced in a press release:

British Minister for Trade, Investment and Small Business, Lord Davies, said: “I am delighted that PharmaTrust has chosen the UK for a major expansion of its business. Its new prescription drug dispensing technology will revolutionize the way medicines are dispensed across the country and beyond.”

PharmaTrust sees the UK as "a key gateway to the European market." The CEO and co-founder, Don Waugh was invited to attend the Global Investment Conference hosted by British Prime Minister Gordon Brown. In the press release, he draws some parallels between PharmaTrust's machine and the first ATMs, introduced in London. Click here for more information about the PharmaTrust MedCentre.

New Study: Telepharmacist Monitoring ICU Patients Increased Sedation Guideline Compliance, Daily Sedation Interruptions, Interventions

A new study published in The Annals of Pharmacotherapy this month by a crew from UMass Memorial Medical Center and University of Massachusetts Medical School shows promising results for patients in intensive care. From Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically Ill Mechanically Ventilated Patients:

RESULTS: The addition of third shift tele-ICU pharmacist support was associated with a significant increase in the percentage of patients who received a daily sedative interruption (45% vs 54%; p < 0.0001). This occurred in the context of significant increases in the total number of ICU pharmacist interventions (36 vs 49.4 per 100 patient days, p < 0.0001), the number of therapeutic interventions (20.4 vs 26.1 per 100 patient days, p < 0.001), and the number of sedative-related interventions (0.9 vs 4.4 per 100 patient days, p < 0.0001).

CONCLUSIONS: Tele-ICU resources can be utilized to increase compliance with an established ICU sedation guideline and extend the benefits that daytime ICU clinical pharmacy services provide. Increased ICU pharmacist availability may have additional benefits not measured in this study.

This is the second study published this month that points to telepharmacy as an effective method for improving patient outcomes. Thanks Allison Forni, Nancy Skehan, Christian Hartman, Dinesh Yogaratnam, Milka Njoroge, Christopher Schifferdecker, and Craig Lilly!

5% of Healthcare Professionals in Malaysia use Telepharmacy

A group of pharmacists at the Universiti Sains Malaysia School of Pharmaceutical Sciences have published a study in this month's issue of the Journal of Clinical and Diagnostic Research entitled "Evaluation Of Knowledge And Perception of Malaysian Health Professionals About Telemedicine" (PDF):

The study doesn't state specifically how each respondent answered the questions, but it's a good bet that this reflects telepharmacy use in hospital pharmacy settings, because 1) 80% of respondents were from hospitals (private and government-run), and 2) "Nurses or medical doctors in clinic settings were excluded since telemedicine is yet to become a common practice in these settings," though telemedicine is defined as Teleradiology, Telesurgery, Telenursing as well as Telepharmacy. While 5% usage is low, this is the first I've heard of telepharmacy in use in Malaysia, whereas 42% of my fellow medical professionals in Malaysia have heard of it before, and as a developing country the only direction telepharmacy practice is headed there is up.

New Study: Telepharmacy an Effective Method of Providing Pharmaceutical Reviews

The Journal of Telemedicine and Telecare has released a new study out of Australia evaluating the effectiveness of remote pharmacist reviews of dispensed medications in rural hospitals without on-site pharmacists. Pharmaceutical review using telemedicine - a before and after feasibility study:

Only 42 of the 116 public hospitals in Queensland employ qualified pharmacists to staff their pharmacies. We undertook a feasibility study to determine if pharmaceutical reviews, undertaken face-to-face by a visiting pharmacist, could be replicated using telemedicine. The study was conducted in two phases, with the same pharmacist coordinating the project from the main hospital to two rural hospitals, which relied on supply nurses for all their pharmaceutical services. All inpatients admitted between October 2006 and May 2007 were included in the study. In Phase I the pharmacist made weekly visits to both facilities, to perform face-to-face pharmaceutical reviews of the current inpatients. In Phase 2, all pharmaceutical reviews were performed remotely by the pharmacist by telephone or videoconference. In Phase 1, 186 pharmaceutical activities were performed (mean 3.9 per patient). Of these, 78 pharmacist-initiated changes were recommended and 47 (60%) were implemented. In Phase 2, a total of 296 activities were performed (mean 3.1 per patient) and of the 140 recommendations made by the remote pharmacist, 74 (53%) were accepted. Of the accepted recommendations, there were 11 major interventions (those with a potential to prevent harm to the patient) in Phase 1 and 32 in Phase 2. There were no significant differences in the pharmaceutical activity rates in the two phases. Telepharmacy therefore may be an effective method of providing pharmaceutical reviews for patients in rural inpatient facilities, without an on-site pharmacist.

Thanks Louise Poulson, Lisa Nissen, and Ian Coombes!

Ontario Hospitals will Dispense Drugs via PharmaTrust Kiosks

The PharmaTrust dispensing machine is set to be deployed in Canadian hospitals in the province of Ontario, according to an Ontario Hospital Association press release:

The OHA and PharmaTrust will collaborate on the installation of telepharmacy prescription-dispensing kiosks in hospitals across the province.

PharmaTrust MedCentre kiosks offer live video pharmacist counseling and quick and safe 24/7 access to prescription and over-the-counter medications, dispensed under the complete control of a pharmacist. The PharmaTrust MedCentre allows patients to simply insert their prescription, pick up the handset and interact live with a pharmacist who provides counselling via two-way video conferencing. The pharmacist is supported by integrated safety features to ensure prescription authenticity, accuracy and patient safety.

If you've been reading this blog for a while, you know that the kiosk was developed by Patient Care Automation Services, Inc with a grant from the National Research Council of Canada, and was trialed in Toronto's Sunnybrook Hospital.

Minnesota Retail Telepharmacy Receives Another Grant

According to this Associated Press article, funds just keep rolling in for the rural community of Adrian, Minnesota's retail pharmacy that employs remote supervision of a pharmacy technician by a pharmacist in another MN city:

The southwestern Minnesota community of Adrian is getting $99,999 to help finance small and emerging businesses. Adrian has already identified the Sterling Drug tele-pharmacy for initial financing, and expects the grant will help create or save six jobs.
The Minnesota projects are among 44 nationwide receiving more than $4 million in stimulus funding.

Previously, the Adrian telepharmacy received a loan and a private grant. Now we're seeing more USDA federal funding for telepharmacy projects!

New Mexico Allows Remote Supervision of Pharmacy Technicians, Prevents Closing of Local Pharmacy

In a newly published paper entitled Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease, researchers analyze a University of New Mexico Health Sciences Center project given the acronym "Health Extension Rural Offices" (aka HEROs) as "a vehicle for its model of health extension." According to the paper, some adjustments were made at the behest of Silver City, NM that allowed improved health services:

UNMHSC College of Pharmacy helped revise New Mexico State Board of Pharmacy regulations to permit pharmacists in larger towns to use a telepharmacy service to supervise local pharmacy technicians in rural and frontier counties. Initiated by the local HERO agent, telepharmacy will permit the local pharmacy to remain open, which is a health and economic benefit to the community.

This happened sometime probably in early 2009, as the paper was submitted in July, accepted in October and finally published now in the first Annals of Family Medicine of 2010.

Technology Allows Pharmacists to Deliver Services from Home

Tammy Worth writes a new article for the Health Care Reform Hub of the American Pharmacists Association's pharmacist.com called "Creating a virtual team: The future for medical homes?" In the article, Worth notes "working virtually" may be the answer to a lot of pharmacy's hurdles. She mentions the venerable North Dakota Telepharmacy Project as well as the lesser known project out of the University of Nebraska Medical Center, where pharmacists work from home to provide inpatient pharmacy services:

Lisa Moffett, PharmD, went to pharmacy school, completed her residency, and then decided to stay at home with her children. When she received a call from the University of Nebraska Medical Center offering her work from home, she jumped at the chance.

Moffett is one of 14 stay-at-home moms, “retired” pharmacists, and moonlighters working for the university’s telepharmacy program. The group provides services to six rural hospitals that either need after-hours pharmacy coverage or do not have a pharmacist on staff.

Their responsibilities are purely clinical. A tollfree number is available for hospital staff to ask their virtual pharmacists questions at any time. The group reviews patient profiles, provides dose adjustments, rounds with physicians via telephone, and even takes part in one hospital’s monthly pharmacy committee meetings—all remotely.

“There are so many different things that this job encompasses,” Moffett said. “We practice inpatient pharmacy in our houses through the computer.”

Worth also highlights how the University of Arizona and a few other College of Pharmacies who are developing programs to provide remote medication therapy management (MTM), involving remote consultations. A telepharmacy equipment company out of North Dakota called Custom Data, Inc. says, “We are trying to build systems and come up with methods for doing tele-MTM through similar systems to what we are using now.”

Minnesota Board of Pharmacy Grants Telepharmacy Variances

Back in September the Minnesota Board of Pharmacy granted and renewed a host of variances for pharmacies around the state:

New variances:
Abbot Northwestern Hospital in Minneapolis was permitted to have a pharmacist provide remote verification of pre-op and post-op orders for the Edina Surgery Center so long as the pharmacist-in-charge remains the same person.

Extension to current variances:
West Duluth Clinic Pharmacy in Duluth was allowed to provide telepharmacy services to the Duluth Clinic in Remer, MN for the duration of two years so long as they continue to make visits and monitor usage.

Re-approved variances:
Cub Pharmacy in Cottage Grove and Cub Pharmacy in Shorewood were permanently allowed pharmacist certification of the prescription medication with use of the digital image of the medication so long as the pharmacist-in-charge remains the same.

Finally, Mercy Hospital Pharmacy in Moose Lake was allowed remote "After Hours Order Entry" of the hospital's physician medication orders when pharmacy is closed from normal business hours of operation from St. Luke's Hospital in Duluth, until 4/1/2011.

Idaho Board of Pharmacy 2009 Year in Review: Telepharmacy eases pharmacist shortage, restores services

The Idaho Board of Pharmacy just released their 2009 Performance Measurement Report. A retail telepharmacy project makes the Performance Highlights list:

We extended a temporary rule that will bring pharmacy services to a remote location in Idaho by means of a telepharmacy. This was a joint effort by the board, the community, our Governor, legislators and Idaho Congressman. We are seeing more of our remote areas lose their community pharmacies and we hope this will be a means of providing our citizens [with a way] to continue to have access to pharmacy services and needed medications.

Click here for the rest of the report.