Details on South Dakota's LDRH Telepharmacy System

According to the Lawrence County Journal out of South Dakota, Lead-Deadwood Regional Hospital recently had an open house that shed some light on the details of their telepharmacy program. A pharmacist supervises remote technicians working at LDRH from another hospital 16 miles away:

A pharmacy tech, such as Marilyn Schwaner, can dispense medications without the physical presence of a pharmacist. LDRH is tied visually through an uplink to the Spearfish Regional Hospital pharmacy. Pharmacists there can oversee a draw of medications and can communicate with voice commands. “It’s a wonderful invention,” Schwaner said.

Smith said that in the past, there were limited hours for a pharmacist to be on site in Deadwood to distribute patient medications. Technicians such as Schwaner had a small window of time to have prescriptions ready and if something was prescribed outside of the special hours, Schwaner would have to send out for the meds to another Regional facility.

Now, Schwaner can dispense medications throughout the day, as needed. “It has increased our hours of access and reduced costs,” Smith said.

This specific implementation of telepharmacy was approved by the South Dakota Pharmacy Board in October.

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.

New Outpatient Telepharmacy to Open in South Dakota

As reported in the Aberdeen News, quoting a print-only newspaper, the Ipswitch Tribune:

As it moves into a new location, Vilas Health and Variety of Ipswich is becoming a full-service retail pharmacy...
Located in the new mall on U.S. Highway 12, the business will make use of a tele-pharmacy. An on-site technician in Ipswich, Sue Morlock, will be supervised by the pharmacy staff at Vilas Pharmacy in Eureka via a visual and audio system.

Here's a link to the (current location of the) Vilas Health and Variety pharmacy.

South Dakota Hospital gets Huge Telepharmacy Equipment Grant

From the Rapid City Journal out of Rapid City, SD, comes this news:

Regional Health of Rapid City will receive a $386,549 federal grant to buy videoconferencing devices to link 15 sites, including rural hospitals as well as clinics, with regional medical resources at three sites in Rapid City. The grant was one of three Distance Learning and Telemedicine grants awarded in South Dakota last week by U.S. Department of Agriculture Rural Development.

Among the goals of the Regional Health project are specialty consultation, tele-dialysis and tele-pharmacy, as well as continuing medical education for providers, according to a Rural Development news release.

South Dakota hospital pilots telepharmacy program

The Lawrence County Journal fills us in with an article on the new telepharmacy pilot project in South Dakota's Lead-Deadwood Regional Hospital:

The total cost of the telepharmacy equipment was just more than $27,000 and will save more than $106,500 annually. Funding was provided in part by a payout from the dissolution of the Western Plains Health Consortium, in part by the LDRH Foundation, with the remainder covered by contingency funding.

The telepharmacy unit’s home setting, which is in LDRH, has two high-resolution digital cameras: One observes the activity of the pharmacy tech. The other allows the pharmacy tech at LDRH to display the medication, the label and the physician order so the medication dispensed can be visualized in real time by the pharmacist located in Spearfish or Rapid City.

The system also allows the pharmacist and pharmacy tech to have a visual/audio conversation.

“A pharmacist does not have to be on site,” Smith said. “It saves us significant personnel expenses in pharmacy wages.”

A smaller blurb with much less info was also printed in the Prairie Business Magazine out of North Dakota.

South Dakota gets new Telepharmacy, helps alleviate pharmacist shortage

From the article:

Just this week, the Eagle Butte location has been officially authorized as a pilot site for telepharmacy. Stephens said. That means a pharmacy technician in Eagle Butte will be able to fill prescriptions under the supervision of a pharmacist who watches the technician work via television, he said.

Stephens said he has noticed a resurgence of young people living in many of the towns Vilas serves. The courier system works well in part because of the nationwide shortage of pharmacists, he said. There are 5,000 unfilled pharmacist openings in the U.S., Stephens said.

Tele-pharmacy plan earns legislative OK

Can start in South Dakota, despite lawsuit potential

PIERRE - South Dakota pharmacists received final legislative clearance Monday to use pharmacy technicians to fill drug prescriptions at remote locations.

But members of the Legislature's rules-review committee raised questions about the lack of clear standards for “limited access” areas where tele-pharmacy would be allowed.

Several committee members warned that lawsuits could result if more definite criteria aren't developed.

The Legislature passed the law authorizing tele-pharmacy in 2007. The Board of Pharmacy has used the past year to develop rules for the new system.

The concept calls for pharmacists to communicate with pharmacy technicians and patients at the remote sites using audio-visual networks. Technicians would perform the physical act of filling the prescriptions.

Ron Huether, executive secretary for the Board of Pharmacy, said the rules will allow prescription services to communities where a pharmacist isn't present.

As an example, he said the Pamida pharmacy in Winner plans to operate a remote pharmacy at a medical clinic in Mission. The room will have restricted access.

Sen. Jean Hunhoff, R-Yankton, focused on what standards will be used to determine which communities have “limited” access to retail pharmacy services.

“It would be subject I guess to board member discretion,” Huether replied.

Hunhoff also noted that the rules don't specifically require service to be suspended while the audio-visual link isn't available.

Rep. Roger Hunt, R-Brandon, said he shared her concern about the ambiguity in the phrase “limited access.” He said there could be legal challenges about distance and types of drugs. He encouraged the Board of Pharmacy to develop better-defined standards.

Huether responded: “This is something we wrestled with a long time in developing rules.”

He said the board doesn't want tele-pharmacy to be used to compete with existing pharmacies in a community.

Asked by Rep. David Lust, R-Rapid City, what would happen if multiple providers sought to provide tele-pharmacy services in the same community, Huether said his opinion was the board probably would allow it.

Lust said this could become a matter of dispute under the “limited access” standard.

No one testified against the proposed rules. The rules-review committee approved the rule 6-0.

“I would certainly hope this would be taken back with the questions asked,” Sen. Jim Hundstad, D-Bath, said. “This is a really new thing. This is something that isn't really defined in many places.”

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