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!