Rural Missouri Hospital Awarded USDA Healthcare Grant, Funds Telepharmacy

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.

Missouri USDA Funds Rural Hospital District's Telepharmacy Program

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.

Ontario Hospitals Request Bids for Remote Medication Order Review

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

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.

TrinityHealth Outfits North Dakota Hospital with Telepharmacy Equipment

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

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.

Rural Idaho Hospitals Look to Telepharmacy to Offer Better Healthcare Services

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...

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

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

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

According to the Lawrence County Journal out of South Dakota, Lead-Deadwood Regional Hospital recently had an open house that shed some light on the details of their telepharmacy program. A pharmacist supervises remote technicians working at LDRH from another hospital 16 miles away:

A pharmacy tech, such as Marilyn Schwaner, can dispense medications without the physical presence of a pharmacist. LDRH is tied visually through an uplink to the Spearfish Regional Hospital pharmacy. Pharmacists there can oversee a draw of medications and can communicate with voice commands. “It’s a wonderful invention,” Schwaner said.

Smith said that in the past, there were limited hours for a pharmacist to be on site in Deadwood to distribute patient medications. Technicians such as Schwaner had a small window of time to have prescriptions ready and if something was prescribed outside of the special hours, Schwaner would have to send out for the meds to another Regional facility.

Now, Schwaner can dispense medications throughout the day, as needed. “It has increased our hours of access and reduced costs,” Smith said.

This specific implementation of telepharmacy was approved by the South Dakota Pharmacy Board in October.

Two Telepharmacy Services Operating in Minnesota Highlighted, Adrian Update (Audio & Video)

Dan Gunderson of Minnesota Public Radio has a great article with multimedia about the two telepharmacy services currently operating in Minnesota with multimedia and some great info. Click here to read the article or listen using the flash player below:

Interesting points:

The Catholic Health Initiative ePharmacy went on line in March of 2009. It now serves 16 hospitals in North Dakota and Minnesota.

Minnesota law doesn't allow telepharmacies, so each one requires an annual waiver by the state board of pharmacy. Minnesota now has nine approved telepharmacies. The board is considering possible changes in the law.
...
There were questions when the telepharmacy project started. Skeptics wondered if pharmacists would make more mistakes filling prescriptions over a video link. Rathke says North Dakota State University recently completed a four-year study which found no difference in the error rate.
...

Thrifty White currently has four telepharmacy sites in North Dakota and four in Minnesota.
Weippert said he expects continued growth in telepharmacy in the six Midwestern states Thrifty White covers.

Catholic Health Initiative's ePharmacy program services hospital pharmacies while Thrifty White services outpatient pharmacies.

Minnesota 2020 also updates us with a video they produced on the telepharmacy in Adrian, MN that Sterling Pharmacy remotely supervises:

Montana Hospital Extends Pharmacy Service to Neighboring Town

Bozeman Deaconess's hospital in Bozeman, Montana has announced they are providing pharmacy services remotely to Bozeman Deaconess Hospital in Big Sky, Montana, about 50 miles away:

A licensed pharmacist at the central Bozeman Deaconess Pharmacy site in Bozeman supervises a registered pharmacy technician at the remote Big Sky telepharmacy site through video conferencing technology. The pharmacist communicates face-to-face in real time with both the technician and the patient through real-time audio, video, and desktop computer links.

South Dakota Hospitals Contract for Telepharmacy Services

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

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

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

December, 2010 Meeting:

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

October, 2010 Meeting:

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

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

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

June, 2010 Meeting:

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

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

April, 2010 Meeting:

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

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

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

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

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

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

Catholic Health Initiatives Hospitals May Soon Use Telepharmacy

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

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

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

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

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

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

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

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

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.

Central Order Entry Site Makes 24/7 Review Affordable for 9 North Dakota Critical Access Hospitals

In the July-August 2010 edition of the Journal of Pharmacy Technology, Charles Peterson, David Scott, Ann Rathke, Patricia Killingsworth and George Hill describe a telepharmacy model where a central site processes orders for 9 North Dakota CAHs, where 24/7 pharmacist review of medication orders was not affordable before:

Background: Smaller, critical access hospitals continue to be challenged in finding sufficient pharmacist staffing to deliver quality pharmacy services. Innovative solutions are being explored, including use of technology, to address the problem of access to pharmacy services in remote rural areas.

Objective: To describe a new telepharmacy model that is being developed in North Dakota; the model establishes a central order entry site (COE site) that provides 24-hour pharmacist staffing and telepharmacy services to rural critical access hospitals within the state.

Methods: Nine rural hospitals in North Dakota established a contractual agreement with a pharmacist-staffed COE site in Fargo to obtain pharmacist staffing and pharmacy services via telepharmacy delivery.

Results: All 9 rural hospitals receiving telepharmacy services from the Catholic Health Initiatives (CHI) COE site are critical access hospitals with 25 beds or less and an average of 6625 community population (range 470–16,010); 9986 doses filled per month (range <100–21,000);

CONCLUSIONS: A telepharmacy model that involves a COE site that provides 24-hour pharmacist staffing with pharmacists who are highly trained and skilled in use of telepharmacy technology and dedicate their full-time jobs to delivery of telepharmacy services to remote rural hospitals is an affordable means of delivering pharmacy services to these hospitals.

New Study: Telepharmacist Monitoring ICU Patients Increased Sedation Guideline Compliance, Daily Sedation Interruptions, Interventions

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!

Ontario Hospitals will Dispense Drugs via PharmaTrust Kiosks

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.