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

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.

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.

ASHP finds 80% of Hospitals without 24/7 Pharmacist Coverage, Publishes RMOP Guidelines, Trumpets RMOP Providers

In the upcoming issue, Drug Topics reports on ASHP's Remote Medication Order Processing guidelines published earlier this year. From the aritlce:

I had all of 2 weeks to fill those slots. It was less expensive and faster to utilize a night pharmacy service."

Stomackin signed with Cardinal Health's Rxe-source, then one of the few national RMOP providers. He still uses the service as coverage for third shift and as a resource while Lewistown builds a computerized physician order-entry system that also requires 24-hour pharmacy support 7 days a week.

Lewistown Hospital is not unusual. The latest ASHP survey found that nearly 80% of hospitals nationwide lack pharmacy coverage at some point during a typical week. The widespread lack of 24/7 coverage combined with mandates to enhance hospital technology are fueling a surge of interest in remote pharmacy management. Community pharmacy is grappling with similar issues as telepharmacy replaces pharmacists in small-town and rural healthcare settings.

ASHP's RMOP Guidelines can be found here (PDF).

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.

Minnesota Board of Pharmacy Grants Telepharmacy Variances

Back in September the Minnesota Board of Pharmacy granted and renewed a host of variances for pharmacies around the state:

New variances:
Abbot Northwestern Hospital in Minneapolis was permitted to have a pharmacist provide remote verification of pre-op and post-op orders for the Edina Surgery Center so long as the pharmacist-in-charge remains the same person.

Extension to current variances:
West Duluth Clinic Pharmacy in Duluth was allowed to provide telepharmacy services to the Duluth Clinic in Remer, MN for the duration of two years so long as they continue to make visits and monitor usage.

Re-approved variances:
Cub Pharmacy in Cottage Grove and Cub Pharmacy in Shorewood were permanently allowed pharmacist certification of the prescription medication with use of the digital image of the medication so long as the pharmacist-in-charge remains the same.

Finally, Mercy Hospital Pharmacy in Moose Lake was allowed remote "After Hours Order Entry" of the hospital's physician medication orders when pharmacy is closed from normal business hours of operation from St. Luke's Hospital in Duluth, until 4/1/2011.

Telepharmacy keeps rural pharmacies open, more than half of CAHs do not have a dedicated pharmacist

The Fall issue of the Rural Monitor Newsletter examines rural pharmacies' challenges as they attempt to compete with internet sales, large pharmacy chains, and the national shortage of pharmacists. Writer Candi Helseth gives the obligatory nod to the North Dakota Telepharmacy Project, and also highlights the use of remote pharmacist services by hospitals for filling the pharmacy services void in rural hospitals:

63 percent of CAHs nationwide ... do not have full-time pharmacists on-site.
...
“It’s pretty obvious that these rural providers aren’t going to be able to find full-time pharmacists even if they can afford them,” Moore said. ”With remote pharmacy, where you can leverage a pharmacist taking care of three to five hospitals, it becomes cost effective for these small hospitals. I hope it’s an idea that takes off in more states because it offers answers for small areas where the retail pharmacist is no longer available as a back-up.”

Read the full article here.

Remote Order Entry constitutes "great leadership", gets hospital recognized by state hospital association

The Kansas Hospital Education and Research Foundation will recognize 5 hospitals in Kansas for innovative health care solutions tomorrow at the Kansas Hospital Association conference in Wichita, according to Josh Heck of the Witchita Business Journal. There were 2 co-winners and 3 honorable mentions:

Via Christi’s honorable mention is for its ePharmacy program to reduce medication errors.

Via Christi added to that effort Tuesday by signing the first hospital outside of its own health system as a subscriber to ePharmacy.

Hiawatha Community Hospital was added following a month-long test period. With the program, an ePharmacist reviews orders for the hospital seven days a week through a remote order entry system under which hospitals scan or fax orders.

As you can see, Via Christi (which we've been covering here) is really turning heads with their "ePharmacy" (aka Telepharmacy) program. They do remote order entry for outlying hospitals, and according to the article, just had Hiawatha Community Hospital sign on.

Comprehensive Pharmacy Services acquires "remote pharmacy technology"

An online business newspaper, the Memphis Commerical Appeal covered Comprehensive's acquisition of a Remote Order Entry company that will allow remote pharmacy services for the pharmacy services giant (original press release):

Upshaw said remote order entry services are fairly new to the pharmacy landscape. Comprehensive Pharmacy began pursuing the market area in 2007.

"Over the past three or four years we've seen (remote pharmacies) gaining credibility and gaining ground," he said. "People are feeling more comfortable about them now that they see quality systems in place to address the information, sharing and (Health Insurance Portability and Accountability Act) issues."

The RxKnights acquisition follows a Comprehensive Pharmacy acquisition last year of MedManagement, the pharmacy management arm of McKesson Corp. That acquisition made Comprehensive Pharmacy the country's largest pharmacy services provider.

More details in the article and press release, both are a bit short on details about the actual program, however. Still noteworthy!

VA to do Remote Order Entry from smartphones?

At the Washington DC VA Medical Center, chief of staff for informatics, Dr. Divya Shroff has been ushering in the use of smartphones for a few functions around the hospital normally performed by people at computers. One thing she sees in their future is Remote Order Entry via smartphones like BlackBerrys or the iPhone. From the ComputerWorld article:

Dr. Shroff sees many of the tasks currently being performed on laptops in medical settings making their ways to smartphone platforms as well. Possible future uses for mobile applications for physician's include remote order entry, remote chart changes, and the ability to read and make notes in real-time on medical materials from anywhere, to name a few, Dr. Shroff says.
...
DCVAMC is already working on an iPhone application for patients, though Dr. Shroff didn't share specifics.

This would be an absolutely amazing and revolutionary use of mobile phone technology for use in the healthcare setting. Here's to hoping they develop the application.

White River Medical Center Uses Meta Pharmacy System to Support Distance Medication Dispensing

Hospital 35 miles away takes advantage of medication safety technologies

Floral Park, NY (PRWEB) January 9, 2009 -- Meta, a supplier of comprehensive medication safety information systems for the healthcare industry, announced today that White River Medical Center (WRMC), located in Batesville, AR, is using its medication information safety system to support remote automated dispensing machines at Stone County Medical Center (SCMC), located 35 miles from the White River facility. Both hospitals are part of the White River Health System.

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."

"Jody's unique concept is an excellent example of how 'thinking outside the box' can overcome many of the challenges that face today's healthcare delivery systems," remarked Sal Barcia, CEO of Meta. "He conceived a way to improve medication dispensing and patient safety using the technology that was available to him. It is our understanding that WRMC and SCMC are the first hospitals in the state of Arkansas to deploy remote order entry. We are pleased that our system has been so effective in reducing medication errors and improving outcomes in the state."

About White River Health System
White River Health System is a not-for-profit, multi-facility healthcare organization serving residents of North Central Arkansas. The system includes two hospitals, numerous medical clinics, physician offices, outpatient therapy centers, long-term care facilities, two home health agencies, hospice, and a home medical equipment company. White River Health System is a major employer in the region with more than 1,300 employees. As a not-for-profit healthcare system, revenues generated over expenses are reinvested into healthcare technology, facility improvements and new clinical services.

Source

Melissa Memorial staff gets high marks in state surveys

By April Peregoy

Melissa Memorial Hospital was the subject of three surveys that took place during the month of September. Reporting at the East Phillips County Hospital Board meeting Tuesday, Sept. 23, administrator John Ayoub was happy to announce the hospital performed very well on all three surveys.
The first was a state survey conducted to make sure the hospital was meeting all the conditions of participation. Ayoub said the survey went well, and he gave staff members a lot of credit for their hard work and cooperation.
Only three minor deficiencies were found, all of which had to do with administration and paperwork areas and not with healthcare procedures.
The first revolved around conflicting policies caused by outdated paperwork that had not yet been upgraded. Ayoub said the hospital is working on bringing all their policies up-to-date. The hospital was also told the Chief of Staff needs to sign off on each department policy.
MMH was also marked down for not currently having an outreach site for pharmaceuticals. This is due to the recent cancelation of the hospital board's contract with Banner Health. The situation is only temporary however, as the board is working on finalizing a contract with Poudre Valley Hospital of Fort Collins to provide telepharmacy services.
Ayoub also pointed out MMH is not the only hospital in this situation, as five other hospitals in northeast Colorado are affected as well.
A follow-up Life Safety Survey was also conducted over the past month. This survey is more facility-focused and is done to make sure all emergency equipment such as emergency doors, fire alarms and fire extinguishers are working properly.
The survey was actually conducted in February and a number of things were found that needed to be corrected. Checking back in to make sure MMH had followed up on these corrections, the September survey found the problems had been fixed.
The final survey was the State Vaccine For Children Survey, which was conducted in the Family Practice Clinic. It is done to make sure the clinic is performing and storing vaccinations properly. Again, Ayoub reported the clinic performed well on the survey.

Staff transitioning to new
electronic record system
The hospital is now beginning the process of switching to an electronic medical records system. According to Ayoub, the first phase of the transition began on Oct. 1 and involves the implementation of practice management software.
After a 90-day training cycle with the new software, the hospital will transition into the electronic record system in early 2009.
Ayoub said the system will greatly benefit patients because their medical charts can be accessed right away. It will also allow the hospital to do its own billing rather than rely on another company to do it for them.
In August, a new documentation form was implemented to help the staff transition into the new system. Chief of staff Dr. Dennis Jelden told the board Tuesday night the new forms have been a big help and the staff is adjusting well to them.
Another computer system purchase request the board is considering is for a claim scrubber. This is a computer application that detects errors made in a claim before it is sent to an insurance company. The purpose is to reduce claim denials due to technical mistakes.
Ayoub said the application could cost as much as $30,000, but would benefit the hospital in the end by improving the efficiency of the payment process with the insurance companies.

Special meeting scheduled
EPCHD will hold a special meeting Tuesday, Oct. 7 to discuss and approve changes recently made to its Ends Statement. The board felt the policy was too important to make a quick decision on it, and wanted some time for review.
A public hearing on the hospital board's budget for 2009 will take place at its next regular meeting, which is scheduled for Tuesday, Oct. 28.

Other business
In other business Sept. 23, the EPCHD board:
-toured the laboratory and heard a general report from lab director Deb Taytum on the department's services and staff.
-was informed Tuesday night Dr. Scott J. Hadley, who treats patients needing emergency dental care, will no longer be available to the hospital. The board is now searching for another dentist in the area to provide this service.
-approved a lease with Harry Sprague to farm the 20-acre empty lot behind the hospital. Ayoub said this was done to save time and money on mowing and to be respectful of the surrounding neighborhood.
-reaffirmed the hospital's policy that EMS attention will be given to all calls that come in, regardless of whether the emergency site is located within district boundaries.
-was informed the hospital had its first on-site helicoptor landing. Ayoub stated some complications did occur, but that it was a good learning experience and next time the staff will be even better prepared.
-canceled its contract with the company that provides the hospital with its Spanish-language phone line. A new contract has already been signed with a different company.
-signed a contract to upgrade and improve the hospital's website. Once the initial upgrades have been made, Ayoub said it is his desire to have a staff member trained to maintain the website.
-was notified the hospital received a $9,000 SHIP grant. MMH is also seeking an emergency preparedness grant.
-heard a presentation from the MMH Foundation that the board is expected to close on a loan in October for the donor recognition wall and MMH history wall.
-approved a bid from EIDE Bailey to provide the hospital's auditing services.
-heard a report from FBLA member Samantha Redfern on the progress being made on the clock tower project. The report showed the club still has $17,000 to raise for the project.
-held a 30-minute executive session to discuss the sale of the old building.

Source

Via Christi to offer electronic pharmacy services

Via Christi Health System announced this week it is planning this fall to launch an electronic pharmacy program that is aimed at giving rural counties better access to medications.

Via Christi, the state's largest health care provider, says its e-Pharmacy incentive will address a statewide pharmacist shortage and bolster patient safety.

"Some Kansas counties do not have a pharmacy or pharmacists and many counties only have one pharmacist," said Jim Garrelts, director of pharmacy at the Via Christi Wichita Health Network in a statement. "This shortage of pharmacists likely contributes to a higher risk of adverse medication events, medication errors and substantial inconvenience."

Six Kansas counties presently have no pharmacist and 31 have only one pharmacist or pharmacy. According to the Pharmacy Manpower Project, by 2020, the national supply of pharmacists is likely to fall short of demand by 157,000 nationwide.

The Kansas Legislature recently earmarked money to increase enrollment in the University of Kansas School of Pharmacy, but the first graduates will not complete their schooling until 2014.

The e-Pharmacy program will utilize a remote order entry system under which licensed pharmacists, working outside of regular hours, such as evenings and overnight, will review scanned or faxed medication orders and patient records. The pharmacists then review and profile the accuracy of the order and authorize the hospital pharmacy system to dispense the drug. The licensed pharmacist also checks for allergies, drug interactions, correct dosage and the patient's pharmaceutical history before authorizing the dispensing of a medication.

The U.S. Department of Health and Human Services wants to reward doctors for successfully adopting electronic prescribing practices. It says e-Pharmacies improves the quality of care, lowers administrative costs and has the potential to eliminate thousands of medication errors every year.

The e-Pharmacy services are being developed in conjunction with hospital pharmacy leaders at Via Christi Health System medical centers and Salina Regional Health Center, which is affiliated with Via Christi. The program is set to begin October among Via Christi's network hospitals, Mercy Regional Health Center in Manhattan and in Mt. Carmel Regional Medical Center in Pittsburg and also will be offered to hospitals outside of the health system.

Source

Pharmacists sell startup business

Service provides remote oversight

Two Wichita pharmacists who created the state's first company to offer remote pharmacy services to rural hospitals have sold their business to Via Christi Health System.

Frontier Pharmacy Services, founded by Mark Gagnon and Tim Smith, uses remote-access technology to bridge the gap between rural Kansas communities and pharmacists caused by a national shortage of pharmacists.

The sale price was not disclosed.

Via Christi said it officially will launch the program this fall, first at its partner hospitals in Manhattan and Pittsburg and later to unaffiliated hospitals around the state that could use additional pharmacist oversight.

"I really see it as a way to enhance the pharmacy services we provide for patients," said Jim Garrelts, pharmacy director for the Via Christi Wichita Health Network. "It will enhance patient safety and expand the ability of our pharmacists to provide clinical services."

Via Christi officials cite studies that estimate the national supply of pharmacists is likely to fall short by 157,000 by 2020. Six Kansas counties have no pharmacists, and 31 have only one pharmacist or pharmacy.

Under the service, pharmacists review hospital medication orders over their computers for accuracy, potential drug interactions and efficacy, then enter the order electronically into a participating hospital's pharmacy system.

For the past year, Gagnon -- a pharmacist for Via Christi Regional Medical Center by day -- and Smith, who recently moved to the Kansas City area, have been servicing Coffeyville Regional Medical Center at night, but inquiries from rural communities in Kansas had started to pick up.

The partners decided to sell after concluding that Via Christi's name recognition and reach far exceeded their own.

"Via Christi already has a great outreach program and can really move this forward," said Gagnon, who will help lead the new program under Via Christi. "Via Christi can offer a lot more than we could. We were having to develop everything ourselves -- we were basically reinventing the wheel."

Garrelts said the hospital system, which had been looking into developing remote pharmacy services for a few years, also is working on a telepharmacy component that will use remote cameras in a two-way interactive system.

With that service, a pharmacist could oversee a pharmacy technician or nurse preparing prescriptions through a video system in real time. Via Christi will be working with the Kansas Board of Pharmacy to approve that service -- hopefully by Oct. 1, Garrelts said.

"As we got into talking about it, we realized (there are) many, many hospitals throughout Kansas who have very little pharmacy coverage, maybe once a week," he said. "We want to share the available pharmacists we do have to cover time at places currently not receiving optimal coverage."

The Via Christi network employs about 45 pharmacists.

Source

Actions Taken by the Georgia State Board of Pharmacy at its March 12 Meeting

Macon, Ga. (March 24, 2008) — The Georgia State Board of Pharmacy held its monthly meeting on Wednesday, March 12, 2008.

The Board adopted revisions to the following rules:

480-13 Hospital Pharmacy Regulations. Provides definitions for Remote Location, Remote Order Entry, and Remote Order Entry Pharmacist.
480-13-.03 Personnel. Provides that the Director of Pharmacy is responsible for the implementation of written policies and the clinical operations and staff protocol of the pharmacy.
480-13-.04 Absence of Pharmacist. Amended. Allows for remote order entry under certain conditions.

The Board accepted the following public consent orders:

Shirley Morris-Adams, Peachtree City: Public reprimand and $500 fine for allowing the pharmacy technician at Southern Crescent Hospital for Specialty Care to access the pharmacy, open the pharmacy and start preparations without the licensed pharmacist present.

Southern Crescent Hospital for Specialty Care, Riverdale: Public reprimand and $500 fine for allowing the pharmacy technician to access the pharmacy, open the pharmacy and start preparations without the licensed pharmacist present.

Nader Afif El-Kareh, Buford: Suspended license for admitting to an arrest for possession of Hydrocodon[e and] Alpra[z]olam[?] and diet pills not in the original containers and not labeled in accordance with Georgia law.

The Georgia State Board of Pharmacy will hold its next meeting Tuesday, April 15 and Wednesday, April 16, 2008 at 10:00 a.m. at the Professional Licensing Boards Division in Macon, Georgia.

Source

Indiana Digital Gateway: Just What the Doctor Ordered

An innovative fiber optic network is improving health care in this underserved rural area.

If you drew a diagonal line across Indiana, you would divide the state neatly into two very different regions: the industrial northeast and the largely rural southwest. The southwest, with its low population density, is still struggling to improve its broadband access, health care facilities, and opportunities for economic development. But now a local telecom provider, Smithville Digital – a subsidiary of Smithville Telephone, Indiana’s largest privately owned telecommunications company – has made a commitment to using fiber optics to boost the region’s development.

The company began building its fiber optic network in 2000 for transport, in order to be less dependent on connections with other carriers. And because the investment coincided with the beginning of the tech bust, transport was the network’s only use for several years. But in 2003, as soon as interest in high-speed networking began picking up, Smithville saw an opportunity for selling Metro Ethernet services over its fiber infrastructure. It renamed its network the Indiana Digital Gateway, drew up a business plan and signed its first clients early in 2004.

Today, the Gateway provides high-speed access to health care facilities, schools, city and county offices, an apartment complex and an industrial park. Smithville Digital hopes to add more customers to the network soon.

Jailhouse Telepsychiatry

The Center for Behavioral Health (CBH), a psychiatric clinic whose main office is in Bloomington, Indiana, has a contract with the Monroe County Sheriff’s Office to evaluate and treat prisoners who need mental-health services, mainly for addiction-related problems.

Until last year, deputy sheriffs would bring prisoners to the clinic, then sit and wait for them outside the door of the treatment room. This arrangement kept deputies idle for long periods, created stress for prisoner patients, and alarmed other patients who found themselves sharing waiting rooms with prisoners and armed guards.

After the Indiana Digital Gateway became available, CBH conferred with the sheriff’s office about how to take advantage of it. The clinic’s psychiatrists felt that while in-person meetings were needed for initial evaluations, followup treatments could be done via videoconference, allowing prisoners to stay at the jail. Using the Gateway and a Polycom videoconferencing solution, they set up soundproof rooms at the clinic and the jail and equipped them with cameras, televisions and microphones. In the summer of 2006, they began seeing clients remotely.

"After a few minutes, everyone forgets it's video."

Getting the ergonomics right took some work, says CBH IT director Chuck Stringer, but the work paid off. “We haven't had a single complaint,” he says wonderingly. “After a few minutes, everyone forgets it’s video.”

As expected, videoconferencing saves time – and taxpayer dollars – associated with transporting prisoners to the clinic. It has other benefits as well. Psychiatrists are happier not to be conducting therapy sessions with armed guards at the door. Most important, prisoners receive treatment on a more regular schedule. In the past, treatment schedules depended on the availability of sheriffs to transport patients; when sheriffs were called away on emergencies, patients didn’t get to see their doctors. Today, this happens much less often.

CBH is now considering setting up cameras in all five of its locations. Videoconferencing between locations will help doctors see patients sooner without having to drive several hours round-trip to distant clinics. It will also let doctors supervise nurses and paraprofessionals in remote offices without having to drive there as often.

Long-Distance Radiology

Bloomington Hospital is a regional health care provider with two hospital locations and a network of five family practice offices; its main facility is across the street from CBH in Bloomington. The hospital had previously leased T1 lines from Smithville but by 2003 it was ready to install higher-bandwidth applications than the T1 lines would allow. “We thought it was a good time to talk to Bloomington about investing in fiber as a substitute,” says Cullen McCarty, president of Smithville Digital. “They could do with one strand of fiber what they couldn't do with a thousand T1’s.”

In 2004, Bloomington Hospital became the first client on the Indiana Digital Gateway. Working with its imaging vendor, McKesson, and with Smithville Digital, the hospital installed a system for sharing medical images between the main hospital in Bloomington, the critical-access hospital 45 miles away, and an affiliated outpatient imaging center. With the centralized imaging system, images can now be acquired at any site and read at any site. Highly paid radiologists no longer have to spend hours on the road, and the worst-case turnaround time for readings has been reduced from several days to several hours. “If you're a patient waiting for an answer, that’s really important,” says Bloomington CIO Mark McMath.

The system also automatically retrieves the patient’s prior images so the radiologist can compare them with the current image. Before the central image archive existed, there wasn’t always a way to get prior images in time for them to be diagnostically useful, McMath says. With so much more information accessible today, fewer repeat tests are necessary, which saves time, money and anxiety for patients.

Hosted Services

Bloomington Hospital is also using its fiber infrastructure for applications beyond medical imaging. For example, it is hosting electronic medical records for the emergency room in the rural hospital as well as for the main hospital. “If your case is too complicated for our Orange County hospital and you get sent to the main hospital, your record goes with you,” McMath explains.

The two hospital locations now also share a pharmacy system. This means that the rural hospital doesn’t need to maintain a nighttime pharmacy staff, but doctors there can still write prescriptions at night and have them filled.

Physicians can use the hospital wireless network to access information from their offices.

At the main hospital, the fiber infrastructure also supports wireless Internet access, which physicians use for remote access to their own systems. While ideally it might be best for all local hospitals and physicians to share a medical-records system, this degree of cooperation has so far proved elusive. Helping doctors access their own medical records systems from the hospital is the next best alternative. “It gives you continuity of care,” McMath says. “It simulates having a combined medical record; there's better information at the point of care.”

Platform for Innovation

McMath looks forward to even more integration in the future. He hopes to extend the metro fiber network throughout Bloomington to all doctors’ offices, and maybe even to their homes. Then specialists will be able to view true diagnostic-quality images away from the hospital (they can already see lower-resolution images if they have broadband access), and will be able to exchange clinical information securely and automatically.

Other new systems are in the works, too. Cardiology imaging is being implemented now, to be followed by a lab system and a clinical decision support system. The decision-support system, which will present physicians with relevant medical literature and guidelines, drug-interaction information, and patient lab results, is expected to result in faster and more accurate treatments for patients.

In fact, there seems to be no end to the ideas that McMath and his medical informatics director, Todd Rowland, M.D., have in mind. The fiber optic network has inspired their creativity. McMath says, “What I like is that, as you get higher bandwidth, there are unanticipated things you can do. It’s a platform for innovation.”

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