Minnesota SBP Grants More After-Hours ROE variances

After a host of after-hours order entry variances from the Minnesota State Board of Pharmacy recently, more hospitals requested and recieved variances in their March 9th, 2011 meeting:

Mayo Health System hospital pharmacies – remote after hours order entry –

Variance Committee recommends approval

o Fairmont Medical Center 200992-002

o Lake City Medical Center 261637-001

o Springfield Medical Center 200325-001

o St James Medical Center 200891-001

o Waseca Medical Center 200753-1

o Immanuel St Joseph Hospital 200743-001

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:

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.”

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 Retail Telepharmacy Receives Another Grant

According to this Associated Press article, funds just keep rolling in for the rural community of Adrian, Minnesota's retail pharmacy that employs remote supervision of a pharmacy technician by a pharmacist in another MN city:

The southwestern Minnesota community of Adrian is getting $99,999 to help finance small and emerging businesses. Adrian has already identified the Sterling Drug tele-pharmacy for initial financing, and expects the grant will help create or save six jobs.
The Minnesota projects are among 44 nationwide receiving more than $4 million in stimulus funding.

Previously, the Adrian telepharmacy received a loan and a private grant. Now we're seeing more USDA federal funding for telepharmacy projects!

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.

Minnesota Sees Need for Telepharmacy in Rural Areas Rising in 2010

The Minnesota Society of Health System Pharmacists just released a position statement assessing the changes they feel are required, called Pharmacy Technician Education, Training and Competency. In the statement, highlight many of the roles technicians are increasingly expected to take on, and use some trends research to speculate on the "Future of Healthcare" in the state:

There will be increasing needs for pharmacists in prescription and telepharmacy to improve services to rural areas of the state.

Is telepharmacy an answer to Swine Flu reducing available pharmacy staff?

According to Kate Traynor writing for ASHP, the Fairview Health Services network of hospitals in Minnesota is considering allowing their pharmacists to work from home in the event they or a family member contracts the flu:

Allowing pharmacists to work off-site is another option under discussion. Knoer said the seven-hospital Fairview Health Services network that includes his medical center has some experience with remote order verification. Specifically, he said, one hospital pharmacy that operates around the clock has verified orders for a smaller hospital with limited pharmacy hours.

"The doctor would write an order, the pharmacists would verify it, and the nurse would get it out of the automated dispensing unit," Knoer said.

In theory, he said, pharmacy staff with remote computer access to the hospital could verify orders from home if schools close and workers need to stay with or near their children.

"We have talked about, in the case where we would have issues with the employees not being able to come to work, we could have employees work from home or another [Fairview] site," Knoer said.

But he cautioned that many issues remain to be discussed before remote order entry can work on a large scale at Fairview.

Yet another problem Telepharmacy can help solve!

Minnesota retail telepharmacy has grand opening

The Minnesota retail pharmacy that opened a few months ago had its grand opening last week in Adrian. Julie Buntjer of the Worthington Daily Globe did a write up on the event and the pharmacy's operations:

Erpestad takes prescriptions at the Adrian telepharmacy and sends digital images of the prescription, the pill bottle and the pills to Sterling Drug in Worthington, where Hagen or a fellow pharmacist must examine each image on the computer screen and approve of the medication before it can be dispensed to the customer.

In addition to digital images, the telepharmacy utilizes web cameras, specialized computer software, voiceover Internet and a dedicated communication line. The technology also provides for one-on-one counseling between the pharmacist in Worthington and the customer in Adrian.

More info on Adrian's telepharmacy grant

As reported here a while back, the City of Adrian, MN received partial funding for its telepharmacy project, which restored pharmacy services to the area, in the form of a grant from the Blandin Foundation. The Nobles County Review fills us in again:

The Blandin Foundation notified the city of Adrian on March 13, 2009 that Adrian had been selected for the $50,000 grant through the Sterling Drug, Inc. telepharmacy project. The city received the funds from the Blandin Foundation and forwarded the funds to Sterling Drug, Inc. for the purchase of the telepharmacy equipment.

It is good to know that grants are available for hi-tech medical projects such as retail telepharmacies. If you are having trouble initiating or restoring pharmacy services to your area, you might borrow from Kevin Norskog's example and research available grants.

Retail Minnesota Telepharmacy up and running

An update on the Minnesota town, Adrian who got their retail pharmacy back in the form of a Telepharmacy, serviced from another town's pharmacy:

After over a year of planning and paperwork Adrian will once again have a pharmacy on Maine Street. Sterling Drug will be opening its telepharmacy in the Government Building on Tuesday, June 2.

This comes from Krisine Kern out of the Nobles County Review. According to a PDF on their website, it looks like telepharmacy equipment provider ScriptPro supplied the equipment (pdf).

Grants, loans for Minnesota city telepharmacy set to bring pharmacy service back to the area

Nobles County Comissioners in Worthington, MN approved of plan to loan $25,000 to the City of Adrian, MN for installation of a telepharmacy in communication with a private pharmacy in Worthington after Adrian was awarded a $50,000 grant for broadband internet from the Blandin Foundation, and the municipality was approved for a $25,000 loan from the Worthington Regional Economic Development Corp.

Julie Buntjer of Minnesota's Worthington Daily Globe writes:

In other action, the board:

Received a request from the City of Adrian for financial assistance to help establish a telepharmacy in the Adrian Government Center.

Bruce Heitkamp, Adrian City Administrator, said the community is working with Sterling Drug of Worthington to establish a pharmacy that would allow a pharmacist to provide adequate consultation to clientele via video and teleconferencing equipment. Plans are to have a pharmacy technician on staff at the Adrian location.

“In the last year, our city council has really taken a look at health care,” said Heitkamp. When the town’s only pharmacy closed a year ago, he said it left residents scrambling for services.

“The clinic in Adrian was concerned about the ability to provide prescriptions to their clientele,” Heitkamp said.

Already the City of Adrian has been approved for a $50,000 Light Speed grant from the Blandin Foundation, and it was approved for a $25,000 loan from the Worthington Regional Economic Development Corp. Heitkamp said the city was looking to the county for another piece of financing for the project. The money would cover the estimated $100,000 cost for the telepharmacy equipment. The cost represents roughly one-fourth of the total project cost.

Commissioners voiced support for the telepharmacy and directed the county administrator to work with the WREDC and the City of Adrian to finalize the funding plan.