New Study: Many US States Neglect Setting Any Telepharmacy Policy

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

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

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

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

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

This remote link allows WRMC pharmacists to provide remote medication order entry and real time review of medication orders for appropriateness of doses, as well as screening for medication allergies and drug-drug interactions. Although 35 miles away, SCMC functions as a virtual nursing unit of WRMC, allowing nurses at SCMC immediate access to medications in their dispensing machines. Two goals are achieved with this arrangement - orders for every patient are reviewed and verified by a pharmacist and nurses have access to medications without using an antiquated medication cart fill each day.

"Implementation of this unique technology has had a significant impact on patient care through the reduction of medication errors, adverse drug reactions and drug-drug interactions," explained Jody Smotherman, PharmD, Co-director of Pharmacy Services at White River Medical Center. "It has also produced improvements in employee and nursing job satisfaction as well as improved drug charge capture. A major unexpected benefit was realized in February of 2008 when an F-3 tornado struck Mountain View, destroyed part of SCMC and forced the closing of the pharmacy area. Without our remote order entry and automated dispensing machines, there would have been no access to medications after the storm."

Another advantage of telepharmacy: disaster relief!

North Dakota Telepharmacy Project Continues to Expand

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

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

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

Medical Centers Extend Telepharmacy to Rural Alaskans

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

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

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

Dispensing Machines, Telepharmacists Fill Void Left by Closing Pharmacies

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

InstyMeds machines

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

...

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

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

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

Video connections

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

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

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

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

...

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

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

Recent Telepharmacy Study Round-Up

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

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

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

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

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

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

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

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

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

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

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

Arizona Outpatient Telepharmacy Program gets Federal Earmark

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

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

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

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

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

Thanks to a reader for pointing this out.

NDSU Telepharmacy Update at the North Dakota Pharmacists Association Convention

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

New Nationwide Grants Provide for Telepharmacy Service in Rural Hospitals

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

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

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