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).