Telepharmacy Blog

Rural Missouri Hospital Awarded USDA Healthcare Grant, Funds Telepharmacy

2011-05-27T19:48:00.005-05:00

News-Leader.com out of Springfield, Missouri writes in their Daily Planner section about a new USDA grant awarded to Citizens Memorial Hospital in Bolivar:

Citizens Memorial Healthcare was awarded a $457,500 grant last month from the U.S. Department of Agriculture to fund educational projects and expand health care services in rural Missouri.

CMH received the grant for a program to manage medications. Rural residents can connect to a pharmacist in the evening and from remote locations with what's called a telepharmacy. The program computerizes managing prescriptions and improves the time it takes to review medication orders. The award was received by Susan Sanders, telehealth coordinator for CMH.

Vermont Telepharmacy Pilot Program Keeps Outpatient Pharmacy Services Alive in Rural Vermont

2011-05-27T19:23:00.010-05:00

Keith McGilvery of WCAX News writes about a state-board approved rural outpatient telepharmacy program that has been running in Plainfield, Vermont for 2.5 years. Even though there's no pharmacist in town, one from Colchester remotely councils patients via a live video link, with a vending machine dispensing drugs to a technician.

The program is expanding Hardwick soon, and "telepharmacies are also up for discussion in Danville, Barton, Concord."

"HealthWatch" Video:

Idaho Pharmacy Regulations Revamp Provides for Remote Supervision of Technicians, More Changes Later

2011-05-18T15:44:00.003-05:00

The Idaho Statesman offers this about Idaho's huge pharmacy regulations overhaul:

REWRITING THE RULE BOOK The board is nearing the end of a three-year effort to rewrite the rules governing pharmacies and other places that dispense medications, such as hospitals and nursing homes. The agency wants to dump the 102 pages of rules created over the years to eliminate antiquated language and extend regulation to some areas that haven’t had it before.
PROPOSED MAJOR CHANGES Two areas the board hopes to regulate more closely are telepharmacies and machines that dispense medications.
Telepharmacies permit pharmacy technicians to fill prescriptions under the supervision of a pharmacist, usually some distance away. In some cases, the technician may be in a small hospital that has a pharmacist for only a short period each day. Idaho has a couple of pilot programs now in telepharmacy. As the programs expand, the state will look at regulations. The machines dispense medications either to pharmacists filling prescriptions or to customers who come into a pharmacy to pick up prescribed medications. Pharmacists can put filled prescriptions into the machines that customers can access with a personal code, ending the need to stand in a long line.
THE PROCESS The board hopes to go to the Legislature in January to repeal the existing rules.
HOW YOU CAN BE HEARD A meeting is planned at 9 a.m. Wednesday, June 22, at the Idaho State Board of Pharmacy office, 1100 Shoreline Lane, Suite 300, Boise. Comments may also be directed to Mark Johnston, executive director, at mark.johnston@bop.idaho.gov.
TO LEARN MORE Go to the Board of Pharmacy’s website at http://bop.accessidaho.org.

Missouri USDA Funds Rural Hospital District's Telepharmacy Program

2011-04-08T13:57:00.004-05:00

Last month, the Rural Development division of the Missouri USDA announced funding for telecommunications, distance learning and telemedicine projects in the state. Among those was:

Citizens Memorial Hospital District, in the southwest Missouri community of Bolivar, received $457,500 for implementing a telemedicine program that centralizes the management of medications. The tele-pharmacy allows rural residents to connect to a pharmacist during evening hours and from remote locations and computerizes the management of prescriptions which greatly improves the timely review of medication orders plus generally improves the efficiencies in all aspects of a pharmacy operation.

Several other telehealth grants were awarded but they didn't specifically mention whether their projects included anything pharmacy specific.

ASCP 2011 Spring Conference Provides a Telepharmacy "Education Session"

2011-04-01T14:23:00.000-05:00

The American Society of Consultant Pharmacists' Spring Conference & Exhibition is running from May 17th through 19th, 2011 in Las Vegas, Nevada. Among their education sessions is an entire lecture about remote pharmacy called "Telepharmacy - A Future Alternative," held from 2:00 PM - 3:15 PM on Tuesday, May 17:

This session describes the operation of a telepharmacy medication dispensing system that provides medication dispensing services among a network of six community health clinics. After attending this session, participants will have a clear picture of how telepharmacy technology can be applied to dispensing of medications and may be able to apply some of the knowledge and practice experiences learned in this session into their dispensing practices. At the conclusion of this activity, the participant will be able to: 1. Describe the operational components of a telepharmacy system; 2. Identify the regulations and protocols that enable a telepharmacy to operate; 3. Describe the advantages and challenges of using a telepharmacy for dispensing services in an ambulatory/community setting; 4. Review potential telepharmacy error sources and suggest methods to reduce dispensing errors; 5. Discuss telepharmacy service patient satisfaction and service outcomes. Universal Activity Number: 0203-0000-11-009-L04-P; 1.25 contact hours

Minnesota SBP Grants More After-Hours ROE variances

2011-03-18T17:46:00.000-05:00

After a host of after-hours order entry variances from the Minnesota State Board of Pharmacy recently, more hospitals requested and recieved variances in their March 9th, 2011 meeting:

Mayo Health System hospital pharmacies – remote after hours order entry –
Variance Committee recommends approval
o Fairmont Medical Center 200992-002
o Lake City Medical Center 261637-001
o Springfield Medical Center 200325-001
o St James Medical Center 200891-001
o Waseca Medical Center 200753-1
o Immanuel St Joseph Hospital 200743-001

European Association of Hospital Pharmacists 2011 Vienna Congress Lecture Will Touch on Telepharmacy

2011-03-17T06:11:00.000-05:00

The 16th Congress of the European Association of Hospital Pharmacists is taking place starting at the end of this month, March 30th through April 1st, 2011 in Vienna, Austria. At least one of the lectures, "A need for hospital pharmacist specialization?" will touch on "Providing telepharmacy services to rural and remote areas."

Ontario Hospitals Request Bids for Remote Medication Order Review

2011-03-16T21:36:00.002-05:00

The Wellington Health Care Alliance in Ontario, Canada has posted a request for proposal for a 1 year contract for a Canadian firm to do order review and entry for three sites for 1 year:

Notice Description:
Telepharmacy Coverage for Wellington Health Care Alliance

Wellington Health Care Alliance is a relationship between North Wellington Health Care and Groves Memorial Community Hospital. We operate three sites:

Louise Marshall Hospital, Mount Forest
Palmerston District Hospital, Palmerston
Groves Memorial Community Hospital, Fergus

Term of Contract will be 1 year from May 1, 2011 to April 30, 2012

Service Requested
• To provide telepharmacy coverage for 2 corporations and 3 hospitals that includes medication order review and pharmaceutical advice to staff and physicians

VA to "Soon" Roll Out Telepharmacy Services in Butler, Pennsylvania

2011-03-16T20:53:00.002-05:00

In an article about their tele-dermatology program, VA Butler makes a quick mention that they "will soon expand to include Tele-Smoking Cessation and Tele-Pharmacy." No real information as to whether they'd be providing the service or receiving the service seems to be available.

Colorado State Board Approves Telepharmacy, Remote Dispensing in Rural Hospital

2011-03-16T08:26:00.000-05:00

The article from the Lamar Ledger from the beginning of the month says it all:

The Prowers Medical Center Board of Directors approved obtaining USDA grant funding to place a tele-pharmacy service at the Holly Medical Clinic. The tele-pharmacy will allow people who receive treatment at the Holly Medical Clinic to get medicine from the tele-pharmacy. Described as similar to an ATM, the machine will be located in the Clinic and will allow those who receive treatment at the Clinic to get their medications in Holly, rather than driving 30 miles to Lamar to refill or obtain new authorized prescriptions. The machine will require identification and will be a benefit to those who live a long distance from Lamar, Prowers Medical Center CEO Jim Fairchild said. It is not the hospital's goal to take business away from pharmacies, he added. Installing the tele-pharmacy machine will simply benefit those patients who can't make the trip to Lamar, Fairchild said.

DrugTopics has Suggestions for State Boards, Praises Remote Chemo Prep

2011-02-14T08:28:00.002-06:00

The newest issue (Feb 15th) of DrugTopics has two articles about telepharmacy. The first is by Ned Milenkovich, PharmD, JD. He has some suggestions for the state boards who haven't written telepharmacy rules yet: Get with it, and do look to other states. Excerpt from Page 2:

Many state pharmacy laws and regulations are devoid of language regulating this area. Telepharmacy is still a novelty, and there is a lag in implementation of new laws after professional and technological innovations are deployed.
Moreover, in the few states where telepharmacy laws exist, there is a lack of uniformity among the various states' measures. Implementation of comprehensive and uniform state laws and regulations would provide a more certain medium for telepharmacy for the marketplace and patient population.
With regard to state laws and regulations in the telepharmacy arena, establishing requirements that any technology used must be able to electronically link drug product at the remote site back to the original packaging from the drug manufacturer would ensure patient safety and offer a de minimus chance of medication dispensing error. By electronically sending the drug product's bar-code information from the remote site back for comparison with the manufacturer's bar code, the electronic indicia of the drug can be confirmed without human intervention.
Similarly, laws and regulations should require that captured images of the drug product and prescription that are labeled and dispensed at the remote site must be retrievable and reviewable by the pharmacy and pharmacist at all times.
Finally, telepharmacy laws and regulations should provide for proper counseling by means of video technology that enables pharmacist and patient to interact directly.

The second article is by Fred Gebhart, called "Technicians key to telepharmacy success in North Dakota" and it praises technicians' roles in telepharmacy. The article's section that might be new to my readership also comes on the second page:

Techs prepare chemotherapy and other IV medications in a typical sterile facility; the supervising is pharmacist linked electronically.
"Even if the pharmacist is sitting in the next room, telepharmacy can give you a higher level of oversight than you have with a traditional sterile-prep situation," he said. "Telepharmacy gives you clear, visual records of drugs, bar codes, syringes — every step of the preparation process."

Rural Washington Hospitals Awarded Telemedicine Grant, Will Upgrade Telepharmacy Equipment

2011-02-11T13:07:00.002-06:00

The US Department of Agriculture's Rural Utilities Services, Distance Learning and Telemedicine Grant Program recently awarded $487,000 to the North Central Washington Health Collaborative (NCWHC), which includes Lake Chelan Community Hospital, as well as other rural public hospitals in Leavenworth, Brewster, Omak, Quincy and Goldendale. From the Kozi Community Radio station article:

The hospital, along with its partners, will receive $487,000 to upgrade and expand their telemedicine network to improve access and bring new healthcare services to the rural communities they serve.
As the coordinating facility in the North Central Washington Health Collaborative (NCWHC), LCCH's award will fund a new ultrasound machine, additional computerized radiology equipment and telepharmacy equipment for the hospital's childbirth and surgical center departments.

TrinityHealth Outfits North Dakota Hospital with Telepharmacy Equipment

2011-02-10T16:43:00.002-06:00

Trinity Health's Foundation just released their "Report to the Community" for the fiscal year 2010, which ended June 30th. They received "nearly $700,000 in gifts" and dispersed this among their hospitals. A North Dakota hospital received part of it. From the release:

Kenmare Community Hospital
Exercise equipment for patients
Telepharmacy equipment to better serve the community

Unfortunately there are no more details.

VA Soliciting Bids for After-Hours Telepharmacy Service at Maine Hospital

2011-02-10T16:20:00.003-06:00

The Federal Business Opportunities website has an offer from the Department of Veterans Affairs to remotely staff the Togus VA Medical Center in Augusta, Maine. Details as follows:

The Togus VA Medical Center in Augusta, ME requires after hours telepharmacy services for inpatients. This entails the vendor providing drug knowledge resources and pharmacist medication order review and entry services. This will include review of authorized physician medication ordered during "after hours" time periods that are scanned, sent, transmitted to or accessed by vendor. Pharmacists will enter via remote access, orders into VAMC medication order entry system. This contract is needed to relieve the present system of after hour's pharmacy orders. This work is presently being performed by VAMC TOGUS staff pharmacists on call and on overtime.

Solicitation Information: This telepharmacy contract will include a base year with 4 option periods at an estimated amount between $50,000 and $100,000 annually. The solicitation documents will be posted at the Federal Business Opportunities website (http://www.fbo.gov) on or about February 15, 2011.

So far there have been nine bids by providers from around the country, mostly from the Northeastern states.

PharmaTrust Receives More Canadian Government Funding

2011-02-10T15:58:00.003-06:00

The Industrial Research Assistance Program, under Canada's National Research Council (NRC-IRAP) is contributing an addition $300,000 to PharmaTrust to "support the software and engineering development activities required to deliver a working prototype of MedHome™. From the press release:

The funding will enable the further development of MedHome™, a personal medication management system that addresses the critical issue of medication compliance, helping patients safely and effectively manage their own medications.

Rural Idaho Hospitals Look to Telepharmacy to Offer Better Healthcare Services

2011-02-10T15:25:00.005-06:00

George Prentice of the Boise Weekly details the use of two machines in Idaho's rural Adams County Health Center named Beatrice and Norman that dispense drugs approved remotely by a pharmacist in Ontario, Oregon. Live video via Skype allows for remote patient consultations should the patient want it. From the article:

You can't believe how thrilled our providers are," said Langston-Groves. "We had this installed here after obtaining a special order from Gov. Otter."
The success in Council has led Langston-Groves to consider duplicating their effort to nearby Valley County where, by all accounts, the need is as great.
...
But administration at McCall Memorial, which just three months ago joined the St. Luke's network of hospitals, isn't so sure they want to see a low-cost clinic near their turf. Two weeks ago, hospital administrators told the McCall Star News that "adding more medical providers could damage our long-term financial viability." But officials back-pedaled a bit when BW asked about the proposal.
"We're going to do a formal assessment to determine the need," said Lee Rhodes, CEO of St. Luke's McCall.
"I really hope the hospital doesn't try to shut this effort down," said Backus. "With these hard times and people struggling as much as they are, I don't know why folks aren't jumping at this. There's no way that a low-cost clinic in Donnelly is going to be, in any way, competition toward a large medical facility in McCall."

Considering that McCall is less than 13 miles away from Donnelly, I don't think it's a big logical leap to worry about considering what the McCall Memorial "administrators" said. Hopefully they will put peoples needs before their own profits...

Kansas Sets New Telepharmacy Regulations

2011-02-10T14:59:00.005-06:00

Out of the January Kansas Register comes the announcement that Kansas has drafted new regulations for Telepharmacies:

K.A.R. 68-17-1 through 68-17-9 is a set of new regulations to address telepharmacy branch pharmacies. The following is a summary of the new regulations:
K.A.R. 68-17-1. Definitions. This regulation defines terms used in the telepharmacy branch pharmacy regulations.
K.A.R. 68-17-2. Status of telepharmacy branch pharmacy. This regulation addresses the status of the telepharmacy branch pharmacy and limits the number of such branch pharmacies a retail pharmacy may have.
K.A.R. 68-17-3. Requirements for approval of location. This regulation establishes the requirement that each location of a telepharmacy branch pharmacy must be approved by the Pharmacy Board and establishes criteria for approval.
K.A.R. 68-17-4. Application for approval of a telepharmacy branch pharmacy. This regulation establishes the requirement of an application for a registration of a proposed telepharmacy branch pharmacy and establishes the required content of the application.
K.A.R. 68-17-5. Equipment requirements. This regulation establishes requirements for equipment in a telepharmacy branch pharmacy and its use.
K.A.R. 68-17-6. Minimum operating requirements. This regulation establishes operating requirements that must be met when a telepharmacy branch pharmacy is open for operations and dispensing drugs.
K.A.R. 68-17-7. Minimum security requirements. This regulation establishes minimum security requirements for the physical location of the telepharmacy branch pharmacy.
K.A.R. 68-17-8. Renewal registration. This regulation establishes the requirement that the registration of a telepharmacy branch pharmacy be renewed with the renewal application of the parent pharmacy by application to the Pharmacy Board.
K.A.R. 68-17-9. Fees. This regulation establishes the fees for the registration and renewal of a registration for a telepharmacy branch pharmacy.

This article from the Kansas Health Institute details problems that gave rise to the new regulations, the reasoning behind the rules, the model they followed in drafting them, and when they're likely to be encoded:

“We should definitely have those approved in March,” she said.
The regulations initially met resistance from retail pharmacists worried that telepharmacy operations would hurt their business.
“A lot of of people were concerned it was going to impact their brick-and-mortar pharmacy,” she said. “We’re trying to make sure we're not doing that. They don't want a Walgreens or somebody in Kansas City setting up a location in their town that doesn't have to be manned by a pharmacist.
"There was some fear we were going to come up with something like that," she said. "But that wouldn't have been acceptable to anybody. We'd rather you go to a real pharmacist in a real pharmacy, but if you're someplace where there’s not a real pharmacist, we want to make sure there's another option.”

2011 North Dakota Rural Health Information Techology Grants Help Expand Telepharmacy Services to Rural Hospital

2011-01-06T16:17:00.003-06:00

Blue Cross Blue Shield of North Dakota put out a press release about the recipients of their Rural Health Grant Program Awards for 2011. Of the $375,000 awarded and seven recipients selected, one was a rural hospital that provides remote pharmacy services. The grant allows them to expand the program further:

Ye Olde Medicine Center of Park River plans to use the funds to expand the Park River telepharmacy services to Drayton, N. D. Drayton recently lost pharmacy services due to the retirement of their pharmacist. This is a cost-effective and efficient way to ensure continuing pharmacy services to the community and to support the local medical providers.

2009: Ross Memorial Hospital in Lindsay, Ontario Receives Pharmacy Services via Telepharmacy

2011-01-06T15:28:00.005-06:00

I just came across an entry in the Canadian Journal of Hospital Pharmacy that highlights Ross Memorial Hospital in Lindsay, Ontario receiving pharmacy services remotely Mon-Fri from an undisclosed pharmacy. The rest of the work is "tech-check-tech".

Details on South Dakota's LDRH Telepharmacy System

2010-12-29T16:09:00.004-06:00

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)

2010-12-21T16:59:00.011-06:00

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

2010-12-21T15:35:00.007-06:00

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

2010-12-20T15:08:00.000-06:00

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

2010-12-18T14:38:00.000-06:00

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

2010-12-16T13:39:00.007-06:00

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

2010-12-16T13:20:00.006-06:00

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

2010-12-14T20:43:00.005-06:00

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

2010-11-23T15:17:00.004-06:00

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

2010-11-23T14:07:00.003-06:00

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

2010-11-16T22:01:00.002-06:00

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"

2010-11-08T18:32:00.003-06:00

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...

2010-09-21T19:57:00.004-05:00

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

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

2010-09-21T16:21:00.005-05:00

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

2010-08-24T19:00:00.003-05:00

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

2010-08-24T18:23:00.002-05:00

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

2010-08-23T19:50:00.008-05:00

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!

2010-08-03T16:46:00.011-05:00

... 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

2010-07-27T20:45:00.003-05:00

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

2010-07-08T20:30:00.005-05:00

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?

2010-07-06T16:57:00.003-05:00

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?

2010-06-28T15:10:00.006-05:00

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

2010-06-24T21:13:00.004-05:00

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 pharmacypractice act, many state boards are just beginning to addressit. The model act addresses the practice of pharmacy acrossstate lines, and the state board directors interviewed generallyagreed that pharmacists should be licensed in the state wherethey are providing the service. States differed on whether apharmacist should be required to be physically located in alicensed pharmacy and how much time the pharmacist should haveto spend onsite. Telepharmacy models being implemented in hospitalsin several states incorporate long-distance supervision of pharmacytechnicians by pharmacists. The models being implemented varyaccording to area, state regulations, hospital ownership, andhospital size and medication order volume. Most hospitals reportedthat they track medication error rates, and some said errorrates have improved since telepharmacy implementation.
Conclusion. The application of telepharmacy in rural hospitals varies acrossthe United States but is not widespread, and many states havenot defined regulations for telepharmacy in hospitals.

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

2010-06-24T21:07:00.002-05:00

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

2010-06-09T19:06:00.002-05:00

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

2010-05-13T16:08:00.012-05:00

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

2010-04-26T20:03:00.007-05:00

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

2010-04-15T16:47:00.006-05:00

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.

US Navy using ScriptPro's Telepharmacy System

2010-04-13T21:10:00.005-05:00

ScriptPro issued a press release today about their Telepharmacy product's use by the United States Navy:

"Our Telepharmacy system operates in a systematic way. It organizes photos, which become part of the electronic record, of the written prescription, the drug image, and patient information. The pharmacist reviews these remotely and then interacts with the patient concerning the proper use of the medication," according to Mike Coughlin, President and CEO of ScriptPro. "Global Internet telecommunications make pharmacists available to multiple locations from virtually anywhere in the world."

They don't provide any numbers or details, but say, "the largest Telepharmacy rollout in history is now underway." Just some background, according to this article from 2007 some Navy facilities were using PickPoint's Remote Dispensing System.

Arizona Outpatient Telepharmacy Program gets Federal Earmark

2010-03-30T20:19:00.004-05:00

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

2010-03-22T21:20:00.007-05:00

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

2010-03-22T21:07:00.003-05:00

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

2010-03-02T19:38:00.002-06:00

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

2010-02-23T19:21:00.004-06:00

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

2010-02-23T17:30:00.005-06:00

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

2010-02-16T18:17:00.006-06:00

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

2010-02-11T15:33:00.007-06:00

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

2010-01-28T15:19:00.003-06:00

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

2010-01-26T13:46:00.005-06:00

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

2010-01-12T12:44:00.004-06:00

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 MexicoState Boardof Pharmacy regulations to permit pharmacists inlarger townsto use a telepharmacy service to supervise localpharmacy techniciansin rural and frontier counties. Initiatedby the local HEROagent, telepharmacy will permit the localpharmacy to remainopen, which is a health and economic benefitto 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

2010-01-12T11:43:00.006-06:00

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

2010-01-05T13:48:00.002-06:00

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

2010-01-05T13:27:00.001-06:00

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.

Maine CAHs Receive Award for Patient Safety Solutions, Will Recommend Telepharmacy

2009-12-23T11:35:00.005-06:00

A collaborative of Maine critical access hospitals has received the New England Rural Health Roundtable's President's Award for implementing new technology, practices and communication to improve patient safety over the course of 18 months and compiled the data:

MeHAF will support the hospitals' efforts to disseminate solutions generated by the project, including medication reconciliation, interventions related to high-alert medications, enhanced patient and staff education, and telepharmacy plans that more closely involve pharmacists in remote regions.

Here's the bulletin from GIH (Grantmakers in Health) with a bit more detail. MeHAF is the Maine Health Access Foundation, who made the announcement.

Medicare Grant Preps Idaho Clinics for Telepharmacy System

2009-12-23T11:12:00.004-06:00

The Idaho State Office of Rural Health guided three grant applicants to some Flex Grants provided by the Medicare Rural Hospital Flexibility Program in August. Benewah Community Hospital and Harms Memorial Hospital were able to implement Electronic Medical Records while Syringa were a bit more advanced:

Syringa Hospital and Clinics ($23,392): Utilization of a telemedicine robot program to increase access to health care services; development of electronic prescribing connectivity for use of Electronic Health Records and in preparation for eventual telepharmacy. Partners: Saint Alphonsus Regional Medical Center and Irwin Drug.

Minnesota Sees Need for Telepharmacy in Rural Areas Rising in 2010

2009-12-21T19:00:00.000-06:00

The Minnesota Society of Health System Pharmacists just released a position statement assessing the changes they feel are required, called Pharmacy Technician Education, Training and Competency. In the statement, highlight many of the roles technicians are increasingly expected to take on, and use some trends research to speculate on the "Future of Healthcare" in the state:

There will be increasing needs for pharmacists in prescription and telepharmacy to improve services to rural areas of the state.

Kansas Mulls New Draft Rules for Hospital and Retail Telepharmacy

2009-12-21T18:24:00.005-06:00

As you know if you've been reading the blog for a while, Kansas is proposing new telepharmacy rules. The Kansas State Board of Pharmacy's September meeting minutes fills us in on their concerns and how far along they are in the process:

Hospital Telepharmacy Update – Mr. Coast presented the update and stated the regulation title has been changed to “Electronic Supervision of Medical Care Facility Pharmacy Personnel”. The draft regulations were presented for the Board’s review. The Board discussed the potential hazard of unintended consequences of telepharmacy being used to reduce pharmacy staffing, which could lead to a decrease in patient safety and quality of care; and that this should be taken into consideration as the regulations are drafted. The Board will forward questions and issues for the task force to discuss and consider. The next task force meeting will be October 26, 2009 in Wichita.

Retail Telepharmacy Regulations and Update – Mr. Coast updated the Board on the retail telepharmacy regulations. Aaron McReynolds, the owner and PIC at Lincoln County Pharmacy in Lincoln, Kansas , connected by phone to tell the Board his issues concerning the current retail telepharmacy draft regulations. He sent his suggestions to the Board several months ago and has requested the Board consider the North Dakota regulations. He requested the telepharmacy regulations allow controlled substances and questioned the feasibility of unit of use packaging. Mr. Coast asked if the Board would be open to allowing controlled substances on a site by site basis. Mr. McReynolds will participate in the next task force meeting to assist in drafting regulations that will resolve his areas of concern. Mr. Forbes needed the Board’s input concerning questions posed by the Attorney General’s Office. The Board reviewed the questions. The task force may address those questions as well as Mr. McReynolds’ issues. The task force will schedule a meeting.

The October minutes haven't been released yet.

Retail Telepharmacy Program in Washington "a big hit", Restores Pharmacy Services to Two Communities

2009-12-10T11:33:00.006-06:00

Julie Garner of the University of Washington Alumni Magazine wrote an interesting article about the use of a central telepharmacy site in Bellevue to improve pharmacy services in the state of Washington:

Bellegrove started telepharmacies at the Mattawa Clinic and Wenatchee Valley Medical's Royal City Clinic in 2008. Here's how it works: The Bellegrove pharmacist talks with technicians and patients at the clinics through the Internet. The techs then fax prescriptions and insurance information to the pharmacist in Bellevue, who provides approval and instructions for filling the prescriptions. The technicians select from 128 prepackaged medications that are most used in community clinic settings.

According to the article, "Singer and his colleagues spent six months working out the telepharmacy concept with the state Board of Pharmacy to receive certification." The Washington State Board of Pharmacy seems very progressive, given the amount of telepharmacy news coming from the state.

Michigan Health Clinic Receives Rural Development Grant for Remote Pharmacists

2009-12-10T11:04:00.004-06:00

Baldwin Family Health Care, which operates a number of family medical clinics in Michigan, is another recipient of the 2009 Distance Learning and Telemedicine Grants from the US Department of Agriculture:

The DLT project connects the applicant with remote pharmacists through tele-pharmacy. Off-site pharmacists will provide prescription dispensing and patient consultation to patients at Baldwin.

The total amount awarded was $52,400. With $13,875 in additional funding, the total project cost is $66,275, according to the USDA's DLT reports (or original PDF) recently released.

Missouri Hospital District receives USDA telepharmacy grant

2009-12-10T10:40:00.003-06:00

The Scotland County Memorial Hospital District, serving Scotland and Schuyler Counties (Memphis area) in northeast Missouri received a $62,622 grant from the US Department of Agriculture, as 1 of 4 Missouri grant recipients from this year's USDA Distance Learning and Telemedicine Program:

This project will connect a hospital, two clinic and a phamacy. The primary purpose is telepharmacy. There will also be upgrades to the existing video-conferencing system which supports remote consultation.

Read the full report here (or Original PDF).

Retail Telepharmacy Rears Head in Singapore!

2009-12-10T10:25:00.003-06:00

Watson's Personal Care Stores, the largest health care and beauty care chain store in Asia, has posted a job listing for a pharmacy technician at a Singapore location:

The successful candidate’s primary responsibility will be to provide telepharmacy services at Pharmacy stores. You will assist Pharmacists in preparing and dispensing medications to customers via Teleconferencing, as well as to assist in the maintenance of the dispensary to fulfill legal requirements.

It sounds like it's just a tech position, and they are calling patient conferencing by a pharmacist via telecommunications "telepharmacy." Still, very cool and this is the first I've heard of this in use in Asia!

South Dakota Hospital gets Huge Telepharmacy Equipment Grant

2009-12-09T17:55:00.006-06:00

From the Rapid City Journal out of Rapid City, SD, comes this news:

Regional Health of Rapid City will receive a $386,549 federal grant to buy videoconferencing devices to link 15 sites, including rural hospitals as well as clinics, with regional medical resources at three sites in Rapid City. The grant was one of three Distance Learning and Telemedicine grants awarded in South Dakota last week by U.S. Department of Agriculture Rural Development.

Among the goals of the Regional Health project are specialty consultation, tele-dialysis and tele-pharmacy, as well as continuing medical education for providers, according to a Rural Development news release.

Telepharmacy keeps rural pharmacies open, more than half of CAHs do not have a dedicated pharmacist

2009-12-09T14:13:00.008-06:00

The Fall issue of the Rural Monitor Newsletter examines rural pharmacies' challenges as they attempt to compete with internet sales, large pharmacy chains, and the national shortage of pharmacists. Writer Candi Helseth gives the obligatory nod to the North Dakota Telepharmacy Project, and also highlights the use of remote pharmacist services by hospitals for filling the pharmacy services void in rural hospitals:

63 percent of CAHs nationwide ... do not have full-time pharmacists on-site.
...
“It’s pretty obvious that these rural providers aren’t going to be able to find full-time pharmacists even if they can afford them,” Moore said. ”With remote pharmacy, where you can leverage a pharmacist taking care of three to five hospitals, it becomes cost effective for these small hospitals. I hope it’s an idea that takes off in more states because it offers answers for small areas where the retail pharmacist is no longer available as a back-up.”

Read the full article here.

Telepharmacy can "improve patient access to pharmaceutical care"

2009-12-09T14:02:00.003-06:00

A new paper by Annie Y. Lam and Dave Rose called Telepharmacy services in an urban community health clinic system appeared in the Journal of American Pharmacists Association last month:

Setting: Suburban western Washington State during 2007 to 2008.
Practice description: Five network clinics without in-house pharmacies are remotely connected to a central pharmacy to provide telepharmacy services.
Results: At five network sites, 12,000 patients received 3,282 new prescriptions per month with webcam-enabled consultations, 589 monthly refill prescriptions, 2,800 pharmacist-provided refill authorizations, and 250 medication assistance referrals. Antibiotics were the most frequently dispensed medications. Pharmacists commented that webcam-enabled interviews provided better privacy and longer counseling duration. Six new staff members (one pharmacist and five pharmacy technicians) were added. Workspace and staff responsibilities were reassigned to facilitate medication prepackaging and ADDS prescription processing.
Conclusion: Expanded application of telepharmacy technology can improve patient access to pharmaceutical care beyond remote medication dispensing to include point-of-care refill authorization and medication assistance referrals. Further research to explore patient-focused services and to assess economic, humanistic, and clinical outcomes of telepharmacy services is needed.

More and more indicators are pointing to telepharmacy being a good way to improve patient care.

New Legislation Paves Way for Remote Dispensing in Ontario, Canada

2009-12-03T13:31:00.001-06:00

The Ontario legislature passed Bill 179, which will allow remote dispensing in the province:

The new legislation will permit PCA Services Inc. of Oakville to roll out its PharmaTrust(TM) Med Centres across the province - something the company has been working towards for four years. Once the regulations are in place, it is expected that Med Centres will be deployed to service patients in medical clinics, hospitals, employer facilities, retail locations, and remote communities that cannot economically support a traditional drug store.

Check out the press release. We've covered the remote prescription dispensing machine previously here at the Telepharmacy Blog, and also this legislation when it was first being considered. Here are some promo videos and news pieces from Youtube:

http://www.youtube.com/watch?v=gU30LnS2qso

http://www.youtube.com/watch?v=J-kGuOu1GQ0

Army, Navy, VA use of Kiosks, Automated Dispensing, Telepharmacy on the Rise

2009-12-01T12:27:00.005-06:00

Christopher Prawdzik from the latest edition of Military Medical Technology wrote a review of the newest pharmacy technologies in use at various military pharmacy facilities called "Less Time to Fill: Advances In Pharmacy Automation Cut Costs, Improve Accuracy And Leave Pharmacists With More Time For Patient Care":

For example, the Navy’s Pensacola, Fla., command has about 11 remote sites in addition to the Pensacola Naval Hospital. Using ScriptPro’s Telepharmacy system, any pharmacist on duty at any of these sites can accept a call at a station and verify that prescriptions are accurate. This includes verifying pictures of individual drugs with the actual filled prescription.

One big bonus of such systems is that instead of spending exorbitant amounts of time on what are essentially administrative or inventory matters, the technology allows pharmacists to do what they were trained to do. That includes understanding the medication needs of patients and ensuring that drug combinations, if multiple drugs are involved, do not lead to adverse interactions.

He talks about automation in use (Omnicell) at Walter Reed, unmanned kiosks where patients pick up prescriptions, and the telepharmacy system in the above quote from the article.

Establishment of Health Information Exchange Facilitates Telepharmacy Service

2009-11-17T21:21:00.007-06:00

InformationWeek published an interesting article today about Health Information Exchanges (networks for sharing patient information between health-systems) in the United States. Marianne Kolbasuk McGee highlights a specific network, the Western Washington Rural Health Care Collaborative where by virtue of the fact that they use an Information Exchange, the hospitals are able to provide telepharmacy services to each other:

The exchange will initially provide the smaller hospitals, some of which have fewer than 25 beds and are located 35 or more miles from other healthcare providers, with telepharmacy services. Patient data, such as allergies, medications, lab results, and demographic information, is collected in a central repository, and pharmacists at one of the facilities can remotely provide assistance to other hospitals.

The article also mentions how 20 billion federal "stimulus" dollars have made it to or are destined for Healthcare IT needs of various health-systems around the US. Health Information Exchanges are one major result, and apparently provide a ready infrastructure for telepharmacy services.

Two quick Telepharmacy updates

2009-11-12T17:19:00.005-06:00

Photo by Tammy Lawson

First, Tammy Lawson of the Times Republican reports that the US government is building a new Veterans Affairs (VA) clinic in Marshalltown, Iowa whose pharmacy will be serviced by remote pharmacists. This no doubt sprung from their other work in Iowa where they identified the program as one of their best and most efficient.

Second, an update on Comprehensive Pharmacy Services' newly acquired remote pharmacy division, now with a new name, comes from a small article buried in Memphis' Commercial Appeal online magazine:

Rx Remote Solutions

Comprehensive Pharmacy Services has renamed its newly acquired remote-order-entry division to Rx Remote Solutions.

Memphis-based CPS bought Napierville, Ill.-based RxKnights Inc. in June for an undisclosed amount.

Rx Remote Solutions employs pharmacists at a call center who answer calls from health care facilities including hospitals, nursing homes and behavioral health centers.

The pharmacists will have access to the facilities' patient files and will be able to review and approve medication orders even late at night.

It will be interesting to see how they do entering the remote pharmacy market around the US. You can bet the Telepharmacy Blog will be covering it.

Remote Order Entry constitutes "great leadership", gets hospital recognized by state hospital association

2009-11-11T17:11:00.012-06:00

The Kansas Hospital Education and Research Foundation will recognize 5 hospitals in Kansas for innovative health care solutions tomorrow at the Kansas Hospital Association conference in Wichita, according to Josh Heck of the Witchita Business Journal. There were 2 co-winners and 3 honorable mentions:

Via Christi’s honorable mention is for its ePharmacy program to reduce medication errors.

Via Christi added to that effort Tuesday by signing the first hospital outside of its own health system as a subscriber to ePharmacy.

Hiawatha Community Hospital was added following a month-long test period. With the program, an ePharmacist reviews orders for the hospital seven days a week through a remote order entry system under which hospitals scan or fax orders.

As you can see, Via Christi (which we've been covering here) is really turning heads with their "ePharmacy" (aka Telepharmacy) program. They do remote order entry for outlying hospitals, and according to the article, just had Hiawatha Community Hospital sign on.

Ontario company attracts "dozens of countries" to its retail telepharmacy machine

2009-10-15T12:35:00.008-05:00

Charlene Close of 680 News out of Toronto did an informative write up on Patient Care Automation Services, Inc from Oakville, ON:

Patient Care Automation Services Inc. (PCAS) is the developer of the PharmaTrust® MedCentre which is designed for use in hospitals, pharmacies, medical clinics and workplaces. About a dozen countries are already interested in the product.
It operates much like an automated bank machine - insert your paper prescription into the machine or pick up a phone, it then connects electronically via video to an actual pharmacist who can answer any questions the patient has and then sign off on the prescription before the drugs are dispensed.

The company received a $1.5-million grant from the National Research Council of Canada today that will assist in further development and marketing it across Canada, the U.S. and the UK.

This is the company the Canadian government expressed an interest in within a press release from October 13th, and was previously covered here at the Telepharmacy blog.

UPDATE 1: October 28, more press on the Telepharmacy machine: Fierce Healthcare ran this article, complete with announcements from Canadian government officials from the National Research Council and the Minister of State for Science and Technology's office about funding the project. The article also has new info about the system's use:

Currently, trials are taking place at Sunnybrook Hospital in Toronto, under the supervision of the hospital's pharmacy; there are production sites at the Albany Clinic, in Toronto, and Cambridge Memorial Hospital, in Cambridge, Ont.
The system is under evaluation as a pandemic response platform by researchers at the University Health Network and the company has also just recently received approval to deploy its system in select locations in the UK.

UPDATE 2: Nov, here is the National Research Council's official statement.

A bunch of Press Releases from companies touting telepharmacy

2009-10-15T12:04:00.003-05:00

Media Advisory/National Research Council Canada: Government of Canada to Announce Significant Investment in Local Company That Will Benefit Health Care:

PCAS is the developer of the PharmaTrust^TM MedCentre, a telepharmacy dispensing and primary care system. The system is designed for applications in hospitals, pharmacies, medical clinics, workplaces and other locations, providing patients with convenient and safe access to prescription drugs.

Baxa Announces IntelliFlowRx™ to Become DoseEdge™ Dose Management System:

The addition of Preparation Modes earlier this year allowed the system to filter and control the dose queue so that oral dose prep, extemporaneous compounding, tele-pharmacy and TPN manual additions can be tracked in addition to IV dose preparations. DoseEdge also was expanded to support TPN processing – allowing orders to be received from the Baxa Abacus™ Order Entry Software.

Hyland honors customers at OnBase Training & Technology Conference who use the ECM software suite in new ways to get notable results:

Thrifty White Pharmacy - Maple Grove, Minnesota

Operating in five states in the northern Midwest, Thrifty White serves rural communities through 89 drugstores, as well as eight Telepharmacy Stores in communities where access to a pharmacist was not previously available.

Pharmacy Techs' education, roles increasingly expanded, now includes telepharmacy

2009-10-08T20:54:00.005-05:00

Modern Medicine's Fred Gebhart published an article today about pharmacy technicians increasing role in running pharmacies and the expanded training and CE that is being required of them in today's (especially in health-systems) pharmacy environment:

More accreditation activity sounds good to Barbara Lacher, BS, R.Ph.Tech, associate professor and assistant director for the North Dakota State College of Science Pharmacy Technician Program. NDSC modeled its technician program based on pharmacy programs focused on professional education. "We don't train somebody to work 'just retail' or 'just hospital,' " Lacher said. "We educate techs to work in all settings, just as we educate pharmacists to work in all settings. That's why we are comfortable with technicians running telepharmacy operations where there is no pharmacist. We know that our techs aren't just trained to perform specific job functions; they're educated professionals."

The underlying cause (a major shortages of pharmacists) isn't mentioned, however, leaving technicians as the only option to run the pharmacy for many health systems, especially in rural areas. While they are increasingly well-trained and educated, patients still need the better-yet educated eye of a pharmacist making the final call on what medications are delivered, making telepharmacy a great option for communities lacking on-site pharmacists.

South Dakota hospital pilots telepharmacy program

2009-10-05T01:30:00.002-05:00

The Lawrence County Journal fills us in with an article on the new telepharmacy pilot project in South Dakota's Lead-Deadwood Regional Hospital:

The total cost of the telepharmacy equipment was just more than $27,000 and will save more than $106,500 annually. Funding was provided in part by a payout from the dissolution of the Western Plains Health Consortium, in part by the LDRH Foundation, with the remainder covered by contingency funding.

The telepharmacy unit’s home setting, which is in LDRH, has two high-resolution digital cameras: One observes the activity of the pharmacy tech. The other allows the pharmacy tech at LDRH to display the medication, the label and the physician order so the medication dispensed can be visualized in real time by the pharmacist located in Spearfish or Rapid City.

The system also allows the pharmacist and pharmacy tech to have a visual/audio conversation.

“A pharmacist does not have to be on site,” Smith said. “It saves us significant personnel expenses in pharmacy wages.”

A smaller blurb with much less info was also printed in the Prairie Business Magazine out of North Dakota.

Ontario pharmacists awarded for telepharmacy work

2009-09-27T22:37:00.003-05:00

Bryan Meadows of the Chronicle Journal writes about Colin J. Pienaar and Maritza du Preez, a pair of pharmacists from Sioux Lookout winning an award at the Ontario Pharmacists' Association annual meeting for getting the first Community hospital joined to the Ontario Telemedicine Network:

In an interview Thursday, Pienaar said the couple was very surprised by the recognition.
“We did everything because we felt it was necessary at the time. We realize now that it was quite a lot of groundbreaking stuff – quite surprisingly.”
...
When they realized this solution only met their patients‘ needs for pharmacy care one or two days a month, Sioux Lookout Remedy‘s Rx became the first community pharmacy to join the Ontario telemedicine network. Today, a video conferencing unit allows patients to see their pharmacist daily through a live television feed, and patient information materials have been translated into Oji-Cree as has a blister medication reminder card.

Is telepharmacy an answer to Swine Flu reducing available pharmacy staff?

2009-09-27T22:17:00.005-05:00

According to Kate Traynor writing for ASHP, the Fairview Health Services network of hospitals in Minnesota is considering allowing their pharmacists to work from home in the event they or a family member contracts the flu:

Allowing pharmacists to work off-site is another option under discussion. Knoer said the seven-hospital Fairview Health Services network that includes his medical center has some experience with remote order verification. Specifically, he said, one hospital pharmacy that operates around the clock has verified orders for a smaller hospital with limited pharmacy hours.

"The doctor would write an order, the pharmacists would verify it, and the nurse would get it out of the automated dispensing unit," Knoer said.

In theory, he said, pharmacy staff with remote computer access to the hospital could verify orders from home if schools close and workers need to stay with or near their children.

"We have talked about, in the case where we would have issues with the employees not being able to come to work, we could have employees work from home or another [Fairview] site," Knoer said.

But he cautioned that many issues remain to be discussed before remote order entry can work on a large scale at Fairview.

Yet another problem Telepharmacy can help solve!

Comprehensive Pharmacy Services acquires "remote pharmacy technology"

2009-09-27T21:54:00.005-05:00

An online business newspaper, the Memphis Commerical Appeal covered Comprehensive's acquisition of a Remote Order Entry company that will allow remote pharmacy services for the pharmacy services giant (original press release):

Upshaw said remote order entry services are fairly new to the pharmacy landscape. Comprehensive Pharmacy began pursuing the market area in 2007.

"Over the past three or four years we've seen (remote pharmacies) gaining credibility and gaining ground," he said. "People are feeling more comfortable about them now that they see quality systems in place to address the information, sharing and (Health Insurance Portability and Accountability Act) issues."

The RxKnights acquisition follows a Comprehensive Pharmacy acquisition last year of MedManagement, the pharmacy management arm of McKesson Corp. That acquisition made Comprehensive Pharmacy the country's largest pharmacy services provider.

More details in the article and press release, both are a bit short on details about the actual program, however. Still noteworthy!

Minnesota retail telepharmacy has grand opening

2009-09-27T21:30:00.003-05:00

The Minnesota retail pharmacy that opened a few months ago had its grand opening last week in Adrian. Julie Buntjer of the Worthington Daily Globe did a write up on the event and the pharmacy's operations:

Erpestad takes prescriptions at the Adrian telepharmacy and sends digital images of the prescription, the pill bottle and the pills to Sterling Drug in Worthington, where Hagen or a fellow pharmacist must examine each image on the computer screen and approve of the medication before it can be dispensed to the customer.
In addition to digital images, the telepharmacy utilizes web cameras, specialized computer software, voiceover Internet and a dedicated communication line. The technology also provides for one-on-one counseling between the pharmacist in Worthington and the customer in Adrian.

Kansas University to use telepharmacy in new building

2009-09-14T23:08:00.003-05:00

Kansas University's West Campus is getting a new building that will house a pharmacy that employs telepharmacy:

A pharmacy is planned for the building, which Audus said would serve KU students, faculty and staff, so as not to compete with other pharmacies in the area. That pharmacy may use automated technology, including tele-pharmacy, he said. That’s similar to a U.S. Navy setup in San Diego where pharmacists there relay information to technicians on ships at sea, who fill the prescriptions for sailors.

The new building should open by August, 2010.

Pennsylvania Hospitals receive technology grant, hope to implement telepharmacy

2009-08-31T10:55:00.006-05:00

The Pennsylvania Mountains Healthcare Resource Development (PMHRD) received a grant from Highmark, reports the Pittsburgh Tribune-Review in a pair of nearly identical articles. Dianne Emminger, VP of IS for ACMH Hospital commented on what they intend to use the grant for:

The funding will be used to purchase equipment and software, Emminger said.

ACMH Hospital will partner with the other hospitals and care centers to provide residents those services, which are in short supply in rural communities, Emminger said.

Emminger gave some examples of how the technology could be used.

...

Another would be tele-pharmacy where remote pharmacists would enter orders into the systems of hospitals that do not have 24-7 pharmacist
...
"The specific projects are still being evaluated for feasibility," Emminger said.

The district of hospitals already has a fiber optic network in place from a grant they received in 2008, so the infrastructure is already in place.

VA to do Remote Order Entry from smartphones?

2009-08-31T10:44:00.004-05:00

At the Washington DC VA Medical Center, chief of staff for informatics, Dr. Divya Shroff has been ushering in the use of smartphones for a few functions around the hospital normally performed by people at computers. One thing she sees in their future is Remote Order Entry via smartphones like BlackBerrys or the iPhone. From the ComputerWorld article:

Dr. Shroff sees many of the tasks currently being performed on laptops in medical settings making their ways to smartphone platforms as well. Possible future uses for mobile applications for physician's include remote order entry, remote chart changes, and the ability to read and make notes in real-time on medical materials from anywhere, to name a few, Dr. Shroff says.
...
DCVAMC is already working on an iPhone application for patients, though Dr. Shroff didn't share specifics.

This would be an absolutely amazing and revolutionary use of mobile phone technology for use in the healthcare setting. Here's to hoping they develop the application.

Two Telepharmacy CE Presentations at NRHA

2009-08-13T18:29:00.004-05:00

UPDATED! There will be two telepharmacy presentations that you can get CE credits for at the National Rural Health Association's "Medication Use in Rural America" conference in Kansas City, Missouri on September 10^th (Conf. Starts the 9^th). David Conejo of Red River Regional Hospital in Bonham, TX, along with Emily Alexander and Becky Harvey of Envision Telepharmacy are presenting:

A telepharmacy case study: Escaping the past and planning for the future
Patient safety, manpower shortages and cost containment help determine the best practice model when hospitals reevaluate pharmacy services. Hear a case study of a critical access hospital in rural Texas using electronic supervision of pharmacy technicians. Topics include obstacles encountered, redirection of resources, a clinical management program addressing medication patient safety goals, and expanding pharmacy services.

Next up is REACH IN (Resources to Enhance the Achievement of Community Health for Indiana)'s presentation entitled Launching your telepharmacy program: It's not about the technology which will "assess the role of community pharmacists by pharmacists and patients in Health Profession Shortage Areas."

Here's a PDF of the entire agenda. See the NRHA website for more details.

Kansas Hospital to Provide Telepharmacy Service to Rural Areas

2009-08-11T19:44:00.003-05:00

Mt. Carmel Regional Medical Center in Pittsburg, KS is looking into delivering remote pharmacy services to rural Kansas. See this article in Pittsburg's Morning Sun newspaper:

Thanks to the telemedicine unit Moran toured Friday, that access has improved greatly over the past couple of years. Members of the Midwest Cancer Alliance demonstrated the equipment — which was purchased thanks to funding that Moran helped secure — by showing Moran a mock workup of Mt. Carmel CEO Jonathan Davis. In the demonstration, Davis and his “physician” were able to converse with a doctor over teleconference while giving the doctor information about Davis’s heart and pulse.
Davis said the technology could be used in a variety of ways, but added that it came in especially vital with cancer patients who could gain access to top-notch cancer physicians without having to travel long distances. Davis said they were currently developing ways to use pharmacy consults for areas without pharmacists as well.

Remote Review of Chemo Orders Saves Time and Money

2009-08-07T16:45:00.009-05:00

Pharmacy Practice News highlights a new and interesting application of remote electronic supervision of pharmacy technicians via live video at Exempla Lutherin Medical Center in Denver, Colorado in their article, ASHP Coverage: Remote Camera To Check Chemotherapy Orders Saves Time and Money (free login required, or use bugmenot):

Prior to implementation of the camera, decentralized pharmacists had to go to the compounding area in the central pharmacy to verify the accuracy of the order. The new process improves efficiency by eliminating the time it takes for the pharmacists to travel to the central pharmacy. The process of traveling to the central pharmacy, waiting for other personnel and completing the check took an average of 346 seconds before the camera was put in place; that was reduced to five seconds with implementation of the camera.

Additionally, after implementing the new system, the Denver pharmacists were able to more than double the number of chemotherapy doses prepared each day, from four to nine.

Great article, it highlights all the points, including that it saves them time, money ($15,000 anually!), and helps them comply with Federal regulations (797).

More info on Adrian's telepharmacy grant

2009-08-03T12:18:00.003-05:00

As reported here a while back, the City of Adrian, MN received partial funding for its telepharmacy project, which restored pharmacy services to the area, in the form of a grant from the Blandin Foundation. The Nobles County Review fills us in again:

The Blandin Foundation notified the city of Adrian on March 13, 2009 that Adrian had been selected for the $50,000 grant through the Sterling Drug, Inc. telepharmacy project. The city received the funds from the Blandin Foundation and forwarded the funds to Sterling Drug, Inc. for the purchase of the telepharmacy equipment.

It is good to know that grants are available for hi-tech medical projects such as retail telepharmacies. If you are having trouble initiating or restoring pharmacy services to your area, you might borrow from Kevin Norskog's example and research available grants.

US Army seeks bids for Telepharmacy maintenance in Missouri

2009-07-06T12:21:00.005-05:00

The Office of US Army Medical Command is soliciting bids for maintaining Telepharmacy equipment for a Robotic dispensing system for the General Leonard Wood Army Hospital in Fort Leonard Wood, Missouri:

PERFORMANCE WORK STATEMENT

1. SCOPE OF WORK: Contractor shall provide all labor, supplies, tools, material, transportation, parts, and equipment to perform Preventive Maintenance (PM), Calibration/Verification/ Certification (CVC), to maintain the Telepharmacy Robotics. This includes unlimited telephonic assistance and unlimited on-site maintenance repairs. The equipment is located in the Pharmacy, General Leonard Wood Army Community Hospital (GLWACH), 126 Missouri Avenue, Fort Leonard Wood, Missouri, 65473.

They will use the lowest cost provider that meets the technical specifications. Bids are due by July 16^th.

North Dakota Company Recieves Federal Grant for Telepharmacy Research

2009-06-30T17:03:00.005-05:00

The United States Department of Agriculture awarded a company involved in starting the North Dakota Telepharmacy Project $80,000 in grant money to research Telepharmacy, reports the Storm Center Blog out of North Dakota:

Evidence shows MTM reduces the use of unnecessary physician and hospital services by reducing adverse health events and in the end total health costs. Research under this grant will be conducted with pharmacies across North Dakota to determine a model for the delivery of MTM services to remote pharmacies.

The results of the research will be used to expand the Telepharmacy Project there.

Telepharmacy system for remote supervision of pharmacy technicians in hospital decreases likelihood of medication errors, increases safety of process

2009-06-24T17:57:00.009-05:00

The culmination of some telepharmacy work out of Kansas, finally published, highlighted earlier by this blog! An article in the newest AJHP details an interesting usage of telepharmacy:

Summary. Telepharmacy hardware and software were acquired, andan inspection camera was placed in a biological safety cabinetto allow the pharmacy technician to take digital photographsat various stages of the chemotherapy preparation process. Oncethe pharmacist checks the medication vials’ agreementwith the work label, the technician takes the product into thebiological safety cabinet, where the appropriate patient isselected from the pending work list, a queue of patient orderssent from the pharmacy information system. The technician thenscans the bar code on the vial. Assuming the bar code matches,the technician photographs the work label, vials, diluents andfluids to be used, and the syringe (before injecting the contentsinto the bag) along with the vial. The pharmacist views allimages as a part of the final product-checking process. Thisprocess allows the pharmacist to verify that the correct quantityof medication was transferred from the primary source to a secondarycontainer without being physically present at the time of transfer.
Conclusion. Telepharmacy and bar coding provide a means to improvethe accuracy of chemotherapy preparation by decreasing the likelihoodof using the incorrect product or quantity of drug. The systemfacilitates the reading of small product labels and removesthe need for a pharmacist to handle contaminated syringes andvials when checking the final product.

Sounds promising -- and a great new method of lowering medication errors in the absence of a pharmacist, as well as costs in pharmacies, though if you've been reading this blog for a while, you know remote verification of pharmacy technician work in hospitals via telecommunications isn't entirely new.

VA hints at retail telepharmacies for rural Alaskans

2009-06-18T18:05:00.004-05:00

In a press release issued by the senior US Senator from Alaska, Lisa Murkowski, Secretary of Veterans Affairs, Eric Shinseki, spoke at a hearing of the Senate Appropriations Veterans Affairs Subcommittee and responded to questions about the VA's future approach to delivering prescription health benefits to veterans in rural areas of the state:

Cross said the VA could help Alaska through “outreach clinics,” such as those slated for Juneau and Homer, and rural health initiatives, including telemedicine programs and prescription deliveries by mail so that veterans don’t have to visit a pharmacy.

“We have much to learn and much innovation to bring forward in regard to our veterans in Alaska and we look forward to working on that,” he said.

Considering that the VA has a good idea of what telepharmacy can offer, and the head of the VA is testifying that this is more or less what they have in mind to the Senators who are going to appropriate the money, it's a good bet it will happen.

Retail Minnesota Telepharmacy up and running

2009-06-08T12:16:00.004-05:00

An update on the Minnesota town, Adrian who got their retail pharmacy back in the form of a Telepharmacy, serviced from another town's pharmacy:

After over a year of planning and paperwork Adrian will once again have a pharmacy on Maine Street. Sterling Drug will be opening its telepharmacy in the Government Building on Tuesday, June 2.

This comes from Krisine Kern out of the Nobles County Review. According to a PDF on their website, it looks like telepharmacy equipment provider ScriptPro supplied the equipment (pdf).

Kansas State Board of Pharmacy reviewing new telepharmacy rules for retail and hospital pharmacies

2009-05-26T15:53:00.005-05:00

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.

...

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.
...
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

2009-05-20T21:50:00.014-05:00

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.