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

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:

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

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

Interesting points:

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

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

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

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

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

Hong Kong Outpatient Remote Pharmacist Conferencing Coming to Retail Stores

A large store chain in Hong Kong called Mannings is getting a remote pharmacist video consultation device for outpatients to consult with a pharmacist at different Mannings stores:

Jardine Matheson Group Managing Director Anthony Nightingale visited three Mannings stores including the recently opened flagship store at the Hang Lung Centre in Causeway Bay, as part of his annual tour of the Group's Hong Kong operations.

During the visit, the Mannings senior team showed Mr Nightingale new initiatives implemented at store level and demonstrated the innovative and first-to-market 'Tele-pharmacy'.

'Tele-Pharmacy' provides shoppers with pharmaceutical advice through a teleconference system link to a pharmacist stationed at another Mannings outlet. This is designed to address the needs of the increasing number of health conscious consumers.

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.

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.”

MedCenters: Pharmacies in a box

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

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.

US Navy's Worldwide Outpatient Telepharmacy Program to be Extended to Inpatients, Army, Air Force?

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.

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.

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.