South Dakota Hospitals Contract for Telepharmacy Services

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

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

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

December, 2010 Meeting:

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

October, 2010 Meeting:

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

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

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

June, 2010 Meeting:

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

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

April, 2010 Meeting:

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

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

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

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

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

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

Catholic Health Initiatives Hospitals May Soon Use Telepharmacy

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

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

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

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

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

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

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

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

VA and IHS to Enhance Access through Development of Telepharmacy

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

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

Newfoundland Supports Local Hospital with Funds for a Chemotherapy Telepharmacy System

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

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

If anyone has any more details please leave a comment.

New Outpatient Telepharmacy to Open in South Dakota

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

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

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

Free webinar from NDTP: "Redefining Healthcare through Telepharmacy"

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

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

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

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

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

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

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

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

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

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

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

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

USDA Visits, Blogs About Minnesota Outpatient Telepharmacy

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

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

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

The USDA also subsequently blogged about it, saying:

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