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

Leaders want wider broadband access

Broadband Internet access may be the answer to a shortage of health-care workers, dwindling employment opportunities and providing declining rural North Dakota school districts with teachers, state leaders say.

They want to make sure broadband, or high speed, access is available and affordable.

To promote broadband connectivity, the U.S. Chamber of Commerce, Chamber of Commerce of Fargo Moorhead and Connected Nation – a national nonprofit organization that works to expand access to and use of broadband Internet – sponsored a community forum in Fargo on Monday.

Cities, counties and schools in North Dakota have 100 percent broadband coverage through a state system, said Lisa Feldner, chief information officer for the state’s Information Technology Department.

She did not know what percentage of the general public has broadband access in the state.

RELATED CONTENT
	WDAY: Connected Nation
	Tracy Frank Archive

Lt. Governor Jack Dalrymple said the state needs to map its broadband accessibility.

Based on a program it conducted in Kentucky, Connected National estimates that increased broadband accessibility could mean a $264 million yearly economic impact in North Dakota, including $186 million in wages from nearly 5,800 new jobs.

The organization also estimates $1.4 million in health-care savings and $13.9 million in mileage savings.

Panelists at the forum gave examples of how broadband is shaping education, health care, agriculture and employment in rural communities.

School districts without the resources to hire teachers for foreign language or advanced math classes can offer those classes with the help of technology, Dalrymple said.

“The answers lie in connectivity and broadband and we have to pursue that aggressively because time is marching on,” he said.

A telepharmacy project allows small towns without pharmacists to continue operating with a registered pharmacy technician connected to a licensed pharmacist through video conferencing, said Ann Rathke, telepharmacy coordinator for the North Dakota State University College of Pharmacy, Nursing and Allied Sciences.

There are 57 telepharmacy sites in the state, with plans to open another 10 starting in September, she said.

An online mapping program from AgriData Inc. in Grand Forks, N.D., allows for more accurate aerial applications, said David Hagert, president and chief executive officer of AgriData.

Farmers can even purchase livestock and equipment through online auctions from the comfort of their homes, said Jeffrey Missling, North Dakota Farm Bureau executive vice president.

“You’re only an e-mail away from being able to do business with a whole new sector of consumers,” he said.

Missling and Don Morton, Microsoft Fargo site leader, said a good example of how broadband access can boost the economy is through companies like Verety.

The Oak Brook, Ill., company allows North Dakotans to take drive-through fast-food orders from all over the country from their homes.

“Broadband allows companies to be in locations where they can attract and keep the very best and brightest people,” Morton said.

Online

www.connectednation.org/economic_impact_study/index.php

- Read the Connected Nation report.

Source (registration required, hint)

New telecommunications grants total nearly $1 million

Governor Jim Doyle announced today that nearly $1 million in grants from Wisconsin's Universal Service Fund (USF) Telemedicine program will be awarded to several non-profit health organizations around the state.

Marshfield Clinic, in Marshfield, received $25,000 to purchase video conferencing equipment, point-of-sale systems, and pharmacy workstations to enable expanding the telepharmacy program to additional communities.

Memorial Hospital of Lafayette Co., in Darlington, received $65,900 to purchase a computed radiology system that will enable 24/7 access to radiologists for reading x-rays.

Source

Lobbying results in Federal funding for Telepharmacy

In an article about Pennsylvania U.S. Senator Bob Casey's federal earmarks, Centre Daily Times reports:

• INRange Systems spent more than $60,000 last year on lobbying. It received $1.6 million for a telepharmacy robotic device unit in Altoona.

ASHP Keeps Federal Government Officials In The Loop On Rural Pharmacy Issues

ASHP recently met with staff from the Health Resources and Services Administration's offices of Rural Health Policy (ORHP) and Pharmacy Affairs as part of a series of ongoing meetings about important Society initiatives to improve pharmacy practice and patient safety in rural settings.

During the meeting ASHP staff presented information on the Society's new Pharmacy Technician Initiative, which partners with state affiliates to push for standardized education, training, certification, and registration requirements for pharmacy technicians. ORHP staffers discussed opportunities for ASHP to work with state offices of rural health policy to advance Initiative.

The meeting participants also discussed ASHP's support for federal legislation that includes pharmacists in federal student loan repayment programs and the expansion of telepharmacy services in practice settings.

ASHP will explore ideas for research ORHP can conduct on topics such as access to pharmacy services in rural healthcare settings.

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

Lawmakers pass drug vending bill

by The garden Island

Posted: Sunday, May 04, 2008 - 12:17:25 am HST

The state Legislature on Tuesday unanimously passed a controversial bill that will allow pharmacists to use remote dispensing machines to help low income residents in rural areas improve their access to prescription drugs.

Senate Bill 2459 evolved through a mixed batch of criticism, including pages of testimony from several Kaua‘i pharmacists.

“It was contentious at times,” state Sen. Gary Hooser, D-Kaua‘i, said Friday. “There was a lot of misunderstanding about the intent of the legislation, but I’m confident that we’ve provided a good compromise.”

Kalaheo Pharmacy Manager Catherine Shimabukuro in late March testified that the bill fails to meet the guidelines of the National Association of Boards of Pharmacy.

“It is clear to me that the intention of the Legislature is to provide prescription care to those who are without insurance,” she says. “This is a noble goal but misguided in its approach to a solution. There are many other avenues that can address this need and all are viable and doable without rewriting the laws that govern the practice of pharmacy.”

Among her arguments, Shimabukuro says there is ample access to pharmacies — negating the need to have remote dispensing machines.

There are some 227 permitted pharmacies in the state, which has a population of nearly 1.3 million residents, according to the state pharmacy board.

State Rep. Roland Sagum, D-16th District, said access means more than physical locations.

“The pricing of these subscription drugs is much cheaper than they can get at a pharmacy,” he said. “It’s for our people who are poor and the indigent.”

The bill, which sunsets in five years, will allow Ho‘ola Lahui Hawai‘i to resume the telepharmacy service that ended two years after it started in October 2005.

Ho‘ola Lahui, a federally qualified health center and Native Hawaiian health care system with offices in Lihu‘e, provides drugs to patients at Kaua‘i Veterans Memorial Hospital in Waimea and Samuel Mahelona Memorial Hospital in Kapa‘a.

“This is especially important for uninsured patients who would not otherwise obtain the drugs they need to improve their immediate health,” Ho‘ola Lahui Board Director Grace Kamai says in her testimony. “HLH provides these medications at a reduced cost to those who otherwise would not be able to afford these medications. The technology allows HLH to reduce costs further by having a central pharmacy location ... dispense acute medication at each clinic.”

Ho‘ola Lahui’s remote dispensing pharmacies were stopped in April 2007 after the state Board of Pharmacy clarified the rules that a pharmacist must be on-site to dispense medications from the machines, Kamai said.

This negated the need for the technology, increased the costs to dispense the necessary medications and decreased patient access to the drugs, according to David Peters, Ho‘ola Lahui chief executive.

Brian Carter, the pharmacist in charge at Lihu‘e Professional Pharmacy, questioned the health center’s motives.

“Ho‘ola Lahui has received money from the federal government to provide aid to the poor and needy people of Hawai‘i,” he said. “What Ho‘ola is doing is using the money that they have received, in good faith, to profit for themselves and put the pharmacies that have served this community for the past 50 years out of business.”

There are 10 independent pharmacies and seven chain retail pharmacies serving Kaua‘i by Carter’s count.

The state pharmacy board chair, Dr. Elwin Goo, testified in favor of the bill with amendments to track the remote dispensing pharmacies.

“The board supports the practice of remote dispensing and believes it is a technology that should be afforded to all pharmacies so that all residents of this state can be afforded easier access to prescription medications to meet their health care needs,” he says. “The board understands and sympathizes with the concerns of the legislature of the financial impact on the small independent pharmacies; however, this bill is not about financial gain or the prosperity of a business, but of the safe dispensing of prescription medications.”

Sagum said the bill is not meant to damage the business of established pharmacies.

“With our economy changing, our needy are getting bigger,” he said. “Many are having a hard time even buying groceries. We want to help them get through this transition time.”

Hooser said community health centers can dispense to very low-income people certain prescription drugs at the cheapest rate available to anyone.

Offering a hypothetical scenario, he said a patient can go to the health center where a doctor will prescribe medication and then have it filled at a remote pharmacy machine.

“It’s not like a vending machine at a shopping mall,” Hooser said. “It’s very controlled. Only certain medications are allowed to be dispensed and an off-site pharmacist does the record keeping.”

The patient will also be in contact with a technician via two-way sound and video monitoring devices, he added.

For more information, visit www.capitol.hawaii.gov.

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

There's a new Telepharmacy grant available...

To non-profits. Summary, full details.

Telepharmacy project receives additional funding

Sen. Byron Dorgan recently notified Charles Peterson, dean of pharmacy, nursing, and allied sciences, that NDSU’s North Dakota Telepharmacy Project has been approved for $813,535 in federal funding for fiscal year 2008. The grant will be funded through the Health Resources and Service Administration's Office for the Advancement of Telehealth.

The funding will be used for developing telepharmacy services to smaller, rural (critical access) hospitals across the state that are struggling to maintain pharmacists staffing and pharmacy services.

According to Peterson, current studies indicate 35 percent of rural hospitals have a pharmacist on site for less than 40 hours per week. Eight percent of hospitals have a pharmacist on site for two hours or less per week. One-third of rural hospitals with 0.5 full-time equivalent or less pharmacists staffing share a pharmacist with another hospital.

“As a result, many rural hospitals have limited pharmacist coverage, which greatly impacts their ability to deliver even the most basic pharmacy services,” said Peterson. “So, there is a critical need for telepharmacy services for remote rural critical access hospitals in North Dakota.”

The project was established in 2002 to restore, retain and establish access to pharmacist and pharmacy services in remote medically underserved rural communities of North Dakota. Peterson hopes to establish a national model for delivering telepharmacy services to remote rural hospitals that will make the state a national leader in delivery of pharmacy services to rural areas.

In early December, NDSU's telepharmacy was a featured program at the American Society of Health-Systems Pharmacists national convention in Las Vegas.

As of September 2007, there are 57 participating pharmacies in 33 medically underserved area counties, including two in Minnesota, serving a population of more than 40,000 rural citizens who previously had no access to a pharmacist or pharmacy services in their own community. The project has added more than 50 new jobs and approximately $12.5 million annually in economic development to the local rural economy. Thus far, the North Dakota Telepharmacy Project has received more than $3.3 million to support its efforts.

For more information, contact Ann Rathke, telepharmacy coordinator, at 1-5863 or ann.rathke@ndsu.edu. David Scott, associate professor of pharmacy practice, is the co-principal investigator and can be reached at 1-5867 or david.scott@ndsu.edu.

Source