Kansas Sets New Telepharmacy Regulations

Out of the January Kansas Register comes the announcement that Kansas has drafted new regulations for Telepharmacies:

K.A.R. 68-17-1 through 68-17-9 is a set of new regulations to address telepharmacy branch pharmacies. The following is a summary of the new regulations:

K.A.R. 68-17-1. Definitions. This regulation defines terms used in the telepharmacy branch pharmacy regulations.

K.A.R. 68-17-2. Status of telepharmacy branch pharmacy. This regulation addresses the status of the telepharmacy branch pharmacy and limits the number of such branch pharmacies a retail pharmacy may have.

K.A.R. 68-17-3. Requirements for approval of location. This regulation establishes the requirement that each location of a telepharmacy branch pharmacy must be approved by the Pharmacy Board and establishes criteria for approval.

K.A.R. 68-17-4. Application for approval of a telepharmacy branch pharmacy. This regulation establishes the requirement of an application for a registration of a proposed telepharmacy branch pharmacy and establishes the required content of the application.

K.A.R. 68-17-5. Equipment requirements. This regulation establishes requirements for equipment in a telepharmacy branch pharmacy and its use.

K.A.R. 68-17-6. Minimum operating requirements. This regulation establishes operating requirements that must be met when a telepharmacy branch pharmacy is open for operations and dispensing drugs.

K.A.R. 68-17-7. Minimum security requirements. This regulation establishes minimum security requirements for the physical location of the telepharmacy branch pharmacy.

K.A.R. 68-17-8. Renewal registration. This regulation establishes the requirement that the registration of a telepharmacy branch pharmacy be renewed with the renewal application of the parent pharmacy by application to the Pharmacy Board.

K.A.R. 68-17-9. Fees. This regulation establishes the fees for the registration and renewal of a registration for a telepharmacy branch pharmacy.

This article from the Kansas Health Institute details problems that gave rise to the new regulations, the reasoning behind the rules, the model they followed in drafting them, and when they're likely to be encoded:

“We should definitely have those approved in March,” she said.

The regulations initially met resistance from retail pharmacists worried that telepharmacy operations would hurt their business.

“A lot of of people were concerned it was going to impact their brick-and-mortar pharmacy,” she said. “We’re trying to make sure we're not doing that. They don't want a Walgreens or somebody in Kansas City setting up a location in their town that doesn't have to be manned by a pharmacist.

"There was some fear we were going to come up with something like that," she said. "But that wouldn't have been acceptable to anybody. We'd rather you go to a real pharmacist in a real pharmacy, but if you're someplace where there’s not a real pharmacist, we want to make sure there's another option.”

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.

Kansas Mulls New Draft Rules for Hospital and Retail Telepharmacy

As you know if you've been reading the blog for a while, Kansas is proposing new telepharmacy rules. The Kansas State Board of Pharmacy's September meeting minutes fills us in on their concerns and how far along they are in the process:

Hospital Telepharmacy Update – Mr. Coast presented the update and stated the regulation title has been changed to “Electronic Supervision of Medical Care Facility Pharmacy Personnel”. The draft regulations were presented for the Board’s review. The Board discussed the potential hazard of unintended consequences of telepharmacy being used to reduce pharmacy staffing, which could lead to a decrease in patient safety and quality of care; and that this should be taken into consideration as the regulations are drafted. The Board will forward questions and issues for the task force to discuss and consider. The next task force meeting will be October 26, 2009 in Wichita.

Retail Telepharmacy Regulations and Update – Mr. Coast updated the Board on the retail telepharmacy regulations. Aaron McReynolds, the owner and PIC at Lincoln County Pharmacy in Lincoln, Kansas , connected by phone to tell the Board his issues concerning the current retail telepharmacy draft regulations. He sent his suggestions to the Board several months ago and has requested the Board consider the North Dakota regulations. He requested the telepharmacy regulations allow controlled substances and questioned the feasibility of unit of use packaging. Mr. Coast asked if the Board would be open to allowing controlled substances on a site by site basis. Mr. McReynolds will participate in the next task force meeting to assist in drafting regulations that will resolve his areas of concern. Mr. Forbes needed the Board’s input concerning questions posed by the Attorney General’s Office. The Board reviewed the questions. The task force may address those questions as well as Mr. McReynolds’ issues. The task force will schedule a meeting.

The October minutes haven't been released yet.

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.

Kansas University to use telepharmacy in new building

Kansas University's West Campus is getting a new building that will house a pharmacy that employs telepharmacy:

A pharmacy is planned for the building, which Audus said would serve KU students, faculty and staff, so as not to compete with other pharmacies in the area. That pharmacy may use automated technology, including tele-pharmacy, he said. That’s similar to a U.S. Navy setup in San Diego where pharmacists there relay information to technicians on ships at sea, who fill the prescriptions for sailors.

The new building should open by August, 2010.

Telepharmacy system for remote supervision of pharmacy technicians in hospital decreases likelihood of medication errors, increases safety of process

The culmination of some telepharmacy work out of Kansas, finally published, highlighted earlier by this blog! An article in the newest AJHP details an interesting usage of telepharmacy:

Summary. Telepharmacy hardware and software were acquired, and an inspection camera was placed in a biological safety cabinet to allow the pharmacy technician to take digital photographs at various stages of the chemotherapy preparation process. Once the pharmacist checks the medication vials’ agreement with the work label, the technician takes the product into the biological safety cabinet, where the appropriate patient is selected from the pending work list, a queue of patient orders sent from the pharmacy information system. The technician then scans the bar code on the vial. Assuming the bar code matches, the technician photographs the work label, vials, diluents and fluids to be used, and the syringe (before injecting the contents into the bag) along with the vial. The pharmacist views all images as a part of the final product-checking process. This process allows the pharmacist to verify that the correct quantity of medication was transferred from the primary source to a secondary container without being physically present at the time of transfer.

Conclusion. Telepharmacy and bar coding provide a means to improve the accuracy of chemotherapy preparation by decreasing the likelihood of using the incorrect product or quantity of drug. The system facilitates the reading of small product labels and removes the need for a pharmacist to handle contaminated syringes and vials when checking the final product.

Sounds promising -- and a great new method of lowering medication errors in the absence of a pharmacist, as well as costs in pharmacies, though if you've been reading this blog for a while, you know remote verification of pharmacy technician work in hospitals via telecommunications isn't entirely new.

Kansas State Board of Pharmacy reviewing new telepharmacy rules for retail and hospital pharmacies

Sarah Green of the Kansas Health Institute writes about upcoming telepharmacy regulation for both retail and hospital pharmacies in the state of Kansas:

The Kansas Board of Pharmacy has new regulations addressing telepharmacies under review, said Debra Billingsley, the board’s secretary.

A task force has met for the past several years to determine what regulations would best allow the expansion of telepharmacies without hurting existing brick-and-mortar businesses.

...

The new regulations are now being reviewed by state agencies; once the Department of Administration and the Attorney General’s office approve the regulations, a public hearing will be conducted. Billingsley expects the regulations to be finalized by the end of the year.

A separate task force recently began meeting to address telepharmacy operations in hospitals.

...

Eventually, once the regulations are in place, the hospital would like to provide access to its ePharmacy system to other facilities, including the state’s critical access hospitals in rural areas, Gagnon said.

“It’s going to be a big change in language of who can do what, and where you can be located,” he said. “It’s going to expand the opportunity to do new things. It’s going to be tricky to keep up with it from a legislative standpoint, as the technology continues to grow.

Add Kansas to the list of State Boards that are willing to admit that technology can help their citizens! The KHI article also has some updates from the news from about a year ago that Via Christi Health System is using telepharmacy to service outlying facilities. Green also gives a summary and update of North Dakota's telepharmacy activities:

Today, the state has 72 telepharmacy sites, arranged in a “hub and spoke” model, that provide services to underserved communities, Peterson said, many with populations between 500 and 1,000 residents. More...

Telepharmacy helps move error rates 'close to zero'?

Helen Figge of the Pharmacy Informatics Section of ASHP writes in US Pharm:

A telepharmacy system has been described at the University of Kansas Hospital in which the chemotherapy preparation process in the pharmacy's sterile room is monitored by bar coding and a camera that documents key steps. The technician scans the bar code on the chemotherapy drug vial to establish a match in the patient's computerized record. Then, in the sterile prep room, the technician captures an electronic image of the vial label and filled syringe prior to injecting the dose into an IV bag. A clinical pharmacist at a remote location then verifies the identity of the drug, the dose on the pulled-back syringe, the label on the IV bag, and the patient's medication order. This telepharmacy process, an alternative to using a robot, features quality assurance steps that are expected to greatly reduce errors.
...
Given the magnitude of morbidity caused by adverse drug events, including medication errors, it is imperative that systematic approaches be taken to redesign the medication dispensing process to eliminate the potential for error. It is conceivable that the combined application of powerful computer software and pharmacy system automation, including robotics, can bring dispensing error rates down close to zero. With the introduction of monitoring methods such as telepharmacy and SORS, the potential exists to continuously monitor dispensed products for correct product and dose, which could further detect and eliminate errors.

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.

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