Colorado State Board Approves Telepharmacy, Remote Dispensing in Rural Hospital

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.

PharmaTrust Receives More Canadian Government Funding

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.

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.

MedCentre Remote Dispensing Machine to expand further in Canada, UK, and soon, USA?

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.

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:

Michigan Health Clinic Receives Rural Development Grant for Remote Pharmacists

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.

New Legislation Paves Way for Remote Dispensing in Ontario, Canada

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

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

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.

US Army seeks bids for Telepharmacy maintenance in Missouri

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.

Ontario, Canada considering retail telepharmacy legislation

Current law in the Canadian province of Ontario restricts the remote dispensation of medication, machines for which already exist and are being tested, and there are amendments to legislation in the works to allow remote dispensing. Check the Ontario College of Pharmacists' entry on the matter.

In an online article from Sault Ste. Marie, Ontario's Sault Star:

Basically, the legislation enables the private sector to install the technology to meet demand, wherever that is, because "right now in Ontario law you have to have a pharmacist physically present," Erwin said.

Two machines have been tested at Toronto's Sunnybrook Hospital since June. British Columbia is already using the technology, he said.

The "ScriptCenter" is one model that holds between 400 and 500 unique patient prescriptions that has been approved in 35 U.S. states, he said.

The rest of the article is opinions from a couple local Ontario pharmacists who seem be more concerned about losing customers to automation than they are with the vast numbers of people who need prescriptions filled in under-served or outright unserviced areas of the province, though it could be that they simply left better reasons unspoken. As the Health Minister spokesman David Caplan seems to have said, "This is just providing another option. In no way is it meant to replace pharmacists."

Tennessee draws up new Telepharmacy rules

In a new PDF on the state board's website, Tennessee has drawn up telepharmacy rules for a pilot project.

Searsport prescribes to telepharmacy technology

SEARSPORT (July 24): The Board of Selectmen voted Tuesday, July 22 to proceed with a grant application that would make Searsport the first town in Maine to explore a new approach to the way pharmacies operate.

At a public hearing, selectmen discussed applying for grant money through the state Community Development Block Grant program to explore the feasibility of bringing a pharmacy into town.

Last year, Waltz Pharmacy closed its Main Street store.

Selectman Dick Desmarais said for several months he has worked on getting a drug store to Searsport, but that he was having difficulty finding a company or individual willing to make a move.

After contacting several in-state pharmacy chains and schools of pharmacy in Massachusetts and Connecticut, Desmarais said he contacted Chris Shrum with Eastern Maine Development Corporation in Bangor.

Two weeks later, Shrum pitched an idea that would bring a pharmacy into Searsport and provide technology to serve health centers in surrounding towns through a networking system of Massachusetts-based company, CBSRx.

Shrum said the firm takes on a variety of roles with regard to prescriptions. CBSRx has been instrumental in getting a profitable pharmacy into the Deer Isle-Stonington community, and has worked with a hospital in Sanford on fine-tuning its existing pharmacy.

“They make sure the hospital takes advantage of all the programs it can, and that they get as much reimbursement as possible from the insurance companies,” said Shrum.

Desmarais, Town Manager James Gillway, Economic Development Committee chairperson Dianne Smith and Shrum met with Jack Hellmann, CEO and president of CBSRx.

“The response was very, very good with them,” said Desmarais, adding it could lead to Searsport residents having a drug store “for many years to come.”

Hellmann, said Shrum, was vice president of operations for Rite Aid when it had 17 stores. Hellmann left Rite Aid 15 years ago after Rite Aid had opened about 2,500 stores.

Then he launched CBSRx.

And, said Shrum, Hellmann has been successful launching pharmacies. Part of Hellmann’s strategy is to conduct a market feasibility study in communities looking to partner with his company to ensure the store is needed.

“He’s figured out how to make it work in rural communities,” said Shrum. “… He’s never closed a pharmacy that he’s opened.”

EMDC, said Shrum, assists the town with the cost of the feasibility study in the form of the CDBG grant. Those grants, said Shrum, are part of a block of money - $12 million to $13 million - that the federal government annually sets aside for the state.

The funding is used for downtown planning, housing rehabilitation and municipal building restoration. for example, a CDBG grant was awarded to Searsport about nine years ago to assist with the cost of restoring Union Hall.

Once the board gives the go-ahead to apply for the CDBG funds, the town submits its grant application for the pharmacy feasibility study. Shrum said it takes four to six weeks to score the application, and if EMDC awards the grant, Searsport must hold another public hearing, followed by a townwide vote to accept the money.

Along with paying for the feasibility study, the funds will help plan ways of building a network of so-called satellite pharmacies.

The plan with CBSRx, said Shrum, would involve the establishment of a hub pharmacy, likely located at the former Waltz Pharmacy site, said Desmarais. That site is equipped with security systems that the state requires for businesses dealing with pharmaceuticals.

Once the hub pharmacy is established, CBSRx would assist in securing sites that could work as satellite pharmacies. The satellite sites, said Shrum, could include health-care facilities in Brooks, Lincolnville, and others under Waldo County Healthcare, Inc. umbrella.

Through that network, technology known in the industry as a "telepharmacy" would dispense medications through what Shrum likened to “candy machines” at satellite locations.

A doctor would prescribe medicine to a patient with a hand-held electronic device. That prescription would arrive at the hub in Searsport. A pharmacist at the hub would program the information for that particular prescription into the medication dispenser at a satellite location.

A physician, qualified nurse or pharmacist at the satellite location would check the prescription before giving it to the patient.

The medicine dispenser has a booth where patients can video conference with the pharmacist at the hub if they have questions about their medications.

Shrum said the nature of Searsport’s CDBG grant application would be the first of its kind in Maine in regard to its approach to how pharmacies operate.

Selectman Doug Norman asked if satellite locations could be susceptible to crime. Gillway said all sites are required to have security systems in place.

Desmarais said the upside is the town would not own the pharmacy; the board had established it did not want ownership.

Instead, Shrum said, an entity such as WCGH could serve as the owner of the pharmacy, and would contract with CBSRx. Shrum plans to meet soon with officials at Waldo County General Hospital to discuss the possibility of including the WCHI sites in the pharmacy network, and of the hospital taking ownership of the hub pharmacy.

Because of all the steps that must be taken to meet state and federal requirements, a hub pharmacy would not likely come to fruition before April, 2009.

Satellite locations would likely be online six to eight months later. The cost of one medication dispensing machine is $50,000 to $75,000, though Shrum said there was funding available to assist with those costs.

Source

Wisconsin Creates Remote-Dispensing Law to Ease Pharmacist Shortage

BETHESDA, MD, 15 May 2008 — As some states struggle with pharmacist shortages, the problem can be especially difficult to resolve for isolated, rural areas.

Wisconsin has created a new law this year aimed at bringing pharmacy services to remote stretches of the state through the practice of remote dispensing.

"The intent here is that pharmacy service can be increased to underserved areas, which right now may be suffering from pharmacy shortage," said Bill Black, legal counsel for the Wisconsin Pharmacy Examining Board.

The details of the law have yet to be written. The pharmacy board will examine a series of pilot programs over the next two years. Specific regulations for the law will be based on the procedures developed during the test programs, Black said.

Parts of northern Wisconsin—and even some urban areas—have little access to pharmacy services. In some cases, the entire health care system consists of a clinic with a physician and a nurse.

Currently, Wisconsin law allows physicians to prescribe and dispense drugs in underserved areas.

"This just provides an additional potential business model instead of a physician-dispensing model," Black said.

A drawback of the physician-dispensing system is that pharmacy-related paperwork can reduce the time available for patients.

"A lot of medical clinics and doctors want to be spending time seeing patients and not necessarily devoting staff time to record keeping as part of the dispensing process," he explained.

The Marshfield Clinic, which has more than 700 physicians, is among the organizations that pushed for a new way to dispense drugs in Wisconsin. The rural health care provider has 43 sites scattered across 40,000 square miles of northern Wisconsin.

"The Marshfield Clinic was very interested in embracing remote supervision of dispensing," said Gary Plank, system director of pharmacy services for the clinic.

The town of Mercer, which sits in northern Wisconsin near Michigan's Upper Peninsula, is a location that could benefit from the new remote dispensing law. In the past few years, the town lost its only community pharmacy after the local pharmacist-owner retired and could not find a buyer, Plank said.

A single clinic, staffed by a physician and a nurse practitioner, served the basic medical needs of the town and surrounding area. The town approached the Marshfield Clinic for help in providing pharmacy services for residents unable to travel to another town that has a pharmacy, Plank said.

Up to 30% of prescriptions go unfilled in some areas, Plank said, often due to the lack of convenient access to a pharmacy. The law should help those patients who may be going without needed drugs due to lack of transportation or rising gas prices.

"We have to be able to remove the barriers to getting" drugs, he said.

Black said technological advances have opened new doors for pharmacies in recent years.

"Through the use of new technology, it is much more possible do a lot of the dispensing functions at a distance," Black said.

Plank said the Marshfield Clinic did some early remote pharmacy work starting in 2003, when pharmacists oversaw the remote creation of antineoplastic drugs at three locations. Now, the group is moving ahead with a wider array of remote services.

Under the Marshfield Clinic's plan, each outlying clinic that participates would include a pharmacy technician with a computer in an examination room stocked with drugs. Video equipment linked to the Internet would connect a pharmacist with the remote technician, he said.

The technician would pull the drugs, create the product label, and enter information into the pharmacy computer system. The pharmacist would view the label, the original prescription, and the contents to approve the transaction.

Patients would then come into the room and communicate with the pharmacist over the video link.

"[A] good feature about this is that the pharmacist will be required to counsel patients regarding their medication before the medication is ultimately dispensed to the patient," Black noted.

An important factor for the Wisconsin Pharmacy Examining Board will be the final stages of the remote dispensing process. There must be security and accountability with the pharmacy technician as he or she finalizes the packaging and the labeling for dispensing, Black said.

"The goal is that the patient will have essentially the same safeguards and protocols applied to them as would happen if they would go to a pharmacy," he said.

Black said the law will help more than Wisconsin's rural residents. There will be opportunities for new partnerships between hospitals with 24-hour pharmacies and those pharmacies operating during limited hours.

"These new rules will also allow partnerships to be formed with other pharmacies that want to pick up some of that work," Black said.

Aurora Health Care, a provider serving southeastern Wisconsin, joined Marshfield Clinic in pushing for the new legislation. The Pharmacy Society of Wisconsin also advocated for the legislative change.

Black said the Wisconsin Pharmacy Examining Board will be watching the various pilot plans for the next two years. The results of the pilot programs will determine the specific rules behind the new law, Black said.

"If it is safe," he said of a proposed plan, "we should be able to find a way to make it work."

Source

Vending machine medicine

For almost seven years, the residents of Pine Bluffs have had only three options for getting prescription drugs: Drive 40 miles to Cheyenne, travel across the border 25 miles to Kimball, Neb., or get them through the mail.

They now have a much closer, more convenient alternative.

Hoy's Drug in Cheyenne, with the help of the University of Wyoming, has opened the first telepharmacy in the state at the University of Wyoming TriCounty Clinic in Pine Bluffs.

Patients simply bring their prescriptions to a pharmacy technician at the clinic. The technician puts the prescription under a video monitoring system so a pharmacist at Hoy's Drug in Cheyenne can read it.

The pharmacist chooses the correct medication on the computer, and it comes out of a 900-pound, bullet-proof "vending machine" back at the clinic in Pine Bluffs.

Through a system of bar codes and checks, the pharmacist makes sure the patient has the correct drug. The technician even shows the pharmacist the actual pills through a video feed, and patients must consult with the pharmacy over the phone or through a video conference.

Dr. Douglas Parks, a family practice physician who works four days a week at the clinic in Pine Bluffs, said the telepharmacy is as safe as any drug store. It has twice as many checks as a retail store.

If a patient needs a medication that is not in the machine, the pharmacy technician will bring it the next morning from Hoy's Drug in Cheyenne and the patient can pick it up at the clinic.

"We are having nine to 10 patients a day who are not having to drive," Parks said. "For a parent who comes in with a sick child, they don't have to bundle up the kid and drive 45 minutes to get medicine."

Jim Massengill, president of Hoy's Pharmacy in Cheyenne, said he had looked at opening a small pharmacy in Pine Bluffs before, but it was just not financially feasible. Massengill said it takes about $500,000 to get a pharmacy up and running.

To open the telepharmacy, Massengill had to buy only the communication systems, the new computers and printers for the telepharmacy and the initial drug inventory. Hoy's Drug also pays the pharmacy technician who works at the telepharmacy.

The actual "vending machine" that holds the medications was purchased through a grant from the UW.

"It's the leading technology," Massengill said. "We already have a lot of technology in place here at Hoy's. It just adds on to what we already do."

Surrounding states have been implementing the idea of telepharmacy for several years. There are more than 20 remote telepharmacies in North Dakota, said Ann Rathke, the telepharmacy coordinator for North Dakota State University.

Parks and Hoy's Drug have been working on this project with the Wyoming Board of Pharmacy since about 2004. At that time, the board could only license a hospital pharmacy or a retail pharmacy, which requires a registered pharmacist on site 80 percent of the time. In 2005, the board drafted legislation to be able to license telepharmacies, and it passed.

The telepharmacy finally began dispensing medications at the end of February but is just now starting to educate the public about the service.

An open house is set from 5 to 7 p.m. today at the clinic for anyone interested in the project.

Tim Seeley, the president of the of the Wyoming Pharmacy Association, said he hopes this is successful because there are a lot of small towns in Wyoming that could use a service like this.

Source

Pill machines ease prescriptions

Mechanical pharmacies made by Pleasanton company help patients in remote locations

By Lea Blevins

MEDIANEWS STAFF

PLEASANTON - Imagine living in a place with no drug store for miles around but still being able to obtain prescription drugs and consult face to face with a pharmacist.

PickPoint Corp., based in Pleasanton, is making that possible. And co-founder Richard Lee promises that it's only just begun to revolutionize the pharmacy world.

Lee is a resident of Volcano, about 60 miles east of Sacramento, but co-founders Kevin Delaney and Peter Swidzinski are from the Tri-Valley. Lee works about three days a week in the Pleasanton office.

Lee has a background in factory automation and was interested in working on packaging for drugs when the PickPoint idea began.

The products are designed to store and dispense prepackaged medications of various types that will increase pharmacy efficiency and provide access to drugs for people in remote locations.

PickPoint's main product resembles a vending machine but is filled with bottles and pill packs instead of candy bars and chips -- and it has bulletproof glass.

The security features allow the machines to be placed in distant locations, such as Alaska's Aleutian Islands, where they may be situated in a hut out in the middle of nowhere.

Doctors and other care providers use PickPoint's computer technology system to request a prescription from a pharmacist in Anchorage, who can speak to the providers via video cameras in real time. The computer program also allows for close-up measuring and viewing of pills to ensure that the prescription is correct.

"This is truly the next generation," Lee said.

In its few years of business, PickPoint has already attracted a wide customer base.

The military uses PickPoint's machines to run what is called a "telepharmacy" for its troops serving in remote locations, including ships.

The machines are installed in more than 125 U.S. Army, Air Force, Navy and public health service locations around the world.

The Alaska Native Medical Center, which uses PickPoint's technology, established the Southcentral Foundation Telepharmacy Program, based in Anchorage, with more than 36,000 patients in a 2,000-mile area.

"You can be anywhere, and we can give you pharmacy assistance and control," Lee said.

In addition to setting up machines in remote sites, PickPoint sells them to hospitals and pharmacies to keep behind the counter. The machines are the same except for the front door, which doesn't include bulletproof glass and allows pharmacy personnel to reach right in and grab the filled prescription.

The pharmacy inside Safeway near the Blackhawk community in Danville features PickPoint's machines behind the counter.

The pharmacy has the vending-machine-style model as well as a set of drawers that light up to direct pharmacists to the location of a prescription.

The machines allow pharmacy staff to save time by reallocating what work they do and when, said pharmacy manager David Flower.

Although pharmacists still have to fill individual bottles of pills and load the machine, the process is speeded up by filling multiple bottles at once instead of filling them as each prescription comes in.

"The best advantage of this thing is when we do have downtime, we're using it up," Flower said.

Lee said PickPoint is currently working on other technology to improve the pharmacy world, but it won't be ready for a few months. He said people can begin to imagine getting their prescriptions filled in seconds rather than what now is often an hour's wait.

"The technology we have coming is so dramatic," Lee said. "This is stuff that people have never seen or heard of."

Source

Pharmacists group honors Phil Montgomery

State Rep. Phil Montgomery, R-Ashwaubenon, has been named Pharmacy Society of Wisconsin 2007 Legislator of the year.

Montgomery has been a vocal advocate for Wisconsin pharmacy on issues such as the state budget and licensing of out-of-state pharmacists, according to the group.

He was instrumental in stopping legislation that would have placed serious restrictions on the ability of pharmacies to purchase prescription drugs from licensed wholesalers. And he is working to develop legislation that would allow for remote dispensing of prescription drugs, according to the group.

Montgomery will be honored at a reception on Wednesday at the Inn on the Park in Madison. The award is presented each year in conjunction with the annual Pharmacy Society of Wisconsin Legislative Day.

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