Broadband Innovations, Part 4: The Doctor Isn't In but Can Still See You

How telehealth is changing the way America gets well.

"Broadband Innovations" is a four-part series that highlights groundbreaking broadband uses, and the people who employ the technology to preserve the past, reshape the future, and fulfill their dreams. This final story in the series focuses on residents of Washington State who receive medical and psychiatric care via video over the Internet.

Timothy Moon's 48 years have been colored by violence. At 16, he was shot. In 1989 he received his first prison sentence. Diagnosed as a manic depressive, Moon finally made a decision about a year ago to get help in dealing with all the anger inside him.

Typically, obtaining medical care would mean transporting Moon, accompanied by two guards, from his cell at Coyote Ridge Corrections Center in Connell, Washington, to a caregiver in Spokane, 100 miles away. A second option would be to have a psychiatrist drive all the way from Spokane to the penitentiary for every consultation.

However, thanks to the Northwest Telehealth network, which uses broadband to provide health care to remote locations, Moon undergoes videoconferencing sessions with his psychiatrist without ever leaving the penitentiary. And he likes it better than meeting in person.

"When I'm in a room by myself, there is less pressure. It's like talking to the camera, which works for me since I find it more difficult to talk about my problems in person," he says.

Moon initially tried confiding in his fellow inmates, but found that it did more harm than good. "You can't just express yourself to anyone. They'll interpret it as weakness and take advantage of it." Having been in a couple of fights, he now tries to stick to himself.

"But it's important to have someone to talk to," he says.

The Benefits of Telehealth

About 50 of the 620 inmates at Coyote Ridge use the network for their health-care needs. Aside from saving tax dollars and improving safety by minimizing the transport of prisoners, the system also discourages prisoners from feigning symptoms to break the monotony of prison's daily routine.

Telehealth executives Brian G. Hoot (left) and Gram McGregor, in front of a monitor showing an emergency room in one of the rural clinics they serve.

"In my experience, 50 percent of the inmates that come to the ER don't need to be here," says Gram McGregor, emergency department manager at Deaconess Medical Center in Spokane.

His ER department is another one of 65 sites throughout eastern Washington and northern Idaho that are connected to the Northwest Telehealth network by broadband speeds of up to 100 megabits per second. Besides penitentiaries, his ER provides rural hospitals and other sites with remote consultations.

McGregor maintains that the remote service is not just about saving money--it's also about improving the quality of care. "Many rural clinics are understaffed. Whether they need an expert consult, a second opinion, or emergency advice, they need to be able to access it remotely," he says.

Prison Saved My Life

Jorge Martinez had lost 145 pounds for no reason that he could pinpoint. He was always tired, but didn't suspect that something was seriously wrong. It was not until Martinez was incarcerated at Coyote Ridge for a narcotics crime that he found out that he was a diabetic.

"Prison saved my life. The way I was eating and drinking, I wouldn't have lasted long," says Martinez, who also says he has been able to turn his health around through hard work and guidance from regular consultations via the telehealth network.

By exercising, Martinez has been able to decrease his insulin dependency by more than half. Through diabetes education in a group over the network, he has also learned how to care for his body and skin. Next he hopes to have a teleconsult with a dietician to work out a meal plan.

Diane Benfield, the dietician at the Washington State Penitentiary in Walla Walla, saves 3 hours of travel per visit due to remote consultations with the inmates at Coyote Ridge. She says this setup allows her to schedule many more appointments with prisoners.

"The inmates are positive and don't seem to mind not meeting in person," she says. "I'd love to see the whole statewide system connected."

How Telehealth Works

In 2003, the TelePharmacy service also became available on the network. It enables nurses in 12 remote hospital sites to access approved prescription medicine through a secure vending machine.

Medication orders transmit via the network from rural hospitals to a pharmacist at Sacred Heart Medical Center in Spokane. The pharmacist reviews the prescription and confirms it on the computer. After swiping an identification card and typing in a password, the nurse at the remote site can take out the drug from the dispenser.

"Many rural communities may have a pharmacist who comes by twice a week, but they can't afford or aren't able to recruit someone full-time," says Fred W. Hoefler, manager of the TelePharmacy program at Sacred Heart.

Ronda Golladay has worked as a nurse for 30 years. Her current employer, the Othello Community Hospital, participates in the TelePharmacy program to provide pharmacy service 24/7. Under its guidelines, nursing staff must be monitored via videoconferencing when performing activities such as restocking the medicine dispenser.

"People are always apprehensive about letting other people watch them in a Big Brother way. We've tried to overcome that by educating them well in how to use the equipment," says Brian G. Hoots, telehealth analyst at Northwest TeleHealth.

In 2007, nearly 300,000 prescription orders went through the system, a number expected to increase as the TelePharmacy program adds two more sites.

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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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Searsport prescribes to telepharmacy technology

SEARSPORT (July 24): The Board of Selectmen voted Tuesday, July 22 to proceed with a grant application that would make Searsport the first town in Maine to explore a new approach to the way pharmacies operate.

At a public hearing, selectmen discussed applying for grant money through the state Community Development Block Grant program to explore the feasibility of bringing a pharmacy into town.

Last year, Waltz Pharmacy closed its Main Street store.

Selectman Dick Desmarais said for several months he has worked on getting a drug store to Searsport, but that he was having difficulty finding a company or individual willing to make a move.

After contacting several in-state pharmacy chains and schools of pharmacy in Massachusetts and Connecticut, Desmarais said he contacted Chris Shrum with Eastern Maine Development Corporation in Bangor.

Two weeks later, Shrum pitched an idea that would bring a pharmacy into Searsport and provide technology to serve health centers in surrounding towns through a networking system of Massachusetts-based company, CBSRx.

Shrum said the firm takes on a variety of roles with regard to prescriptions. CBSRx has been instrumental in getting a profitable pharmacy into the Deer Isle-Stonington community, and has worked with a hospital in Sanford on fine-tuning its existing pharmacy.

“They make sure the hospital takes advantage of all the programs it can, and that they get as much reimbursement as possible from the insurance companies,” said Shrum.

Desmarais, Town Manager James Gillway, Economic Development Committee chairperson Dianne Smith and Shrum met with Jack Hellmann, CEO and president of CBSRx.

“The response was very, very good with them,” said Desmarais, adding it could lead to Searsport residents having a drug store “for many years to come.”

Hellmann, said Shrum, was vice president of operations for Rite Aid when it had 17 stores. Hellmann left Rite Aid 15 years ago after Rite Aid had opened about 2,500 stores.

Then he launched CBSRx.

And, said Shrum, Hellmann has been successful launching pharmacies. Part of Hellmann’s strategy is to conduct a market feasibility study in communities looking to partner with his company to ensure the store is needed.

“He’s figured out how to make it work in rural communities,” said Shrum. “… He’s never closed a pharmacy that he’s opened.”

EMDC, said Shrum, assists the town with the cost of the feasibility study in the form of the CDBG grant. Those grants, said Shrum, are part of a block of money - $12 million to $13 million - that the federal government annually sets aside for the state.

The funding is used for downtown planning, housing rehabilitation and municipal building restoration. for example, a CDBG grant was awarded to Searsport about nine years ago to assist with the cost of restoring Union Hall.

Once the board gives the go-ahead to apply for the CDBG funds, the town submits its grant application for the pharmacy feasibility study. Shrum said it takes four to six weeks to score the application, and if EMDC awards the grant, Searsport must hold another public hearing, followed by a townwide vote to accept the money.

Along with paying for the feasibility study, the funds will help plan ways of building a network of so-called satellite pharmacies.

The plan with CBSRx, said Shrum, would involve the establishment of a hub pharmacy, likely located at the former Waltz Pharmacy site, said Desmarais. That site is equipped with security systems that the state requires for businesses dealing with pharmaceuticals.

Once the hub pharmacy is established, CBSRx would assist in securing sites that could work as satellite pharmacies. The satellite sites, said Shrum, could include health-care facilities in Brooks, Lincolnville, and others under Waldo County Healthcare, Inc. umbrella.

Through that network, technology known in the industry as a "telepharmacy" would dispense medications through what Shrum likened to “candy machines” at satellite locations.

A doctor would prescribe medicine to a patient with a hand-held electronic device. That prescription would arrive at the hub in Searsport. A pharmacist at the hub would program the information for that particular prescription into the medication dispenser at a satellite location.

A physician, qualified nurse or pharmacist at the satellite location would check the prescription before giving it to the patient.

The medicine dispenser has a booth where patients can video conference with the pharmacist at the hub if they have questions about their medications.

Shrum said the nature of Searsport’s CDBG grant application would be the first of its kind in Maine in regard to its approach to how pharmacies operate.

Selectman Doug Norman asked if satellite locations could be susceptible to crime. Gillway said all sites are required to have security systems in place.

Desmarais said the upside is the town would not own the pharmacy; the board had established it did not want ownership.

Instead, Shrum said, an entity such as WCGH could serve as the owner of the pharmacy, and would contract with CBSRx. Shrum plans to meet soon with officials at Waldo County General Hospital to discuss the possibility of including the WCHI sites in the pharmacy network, and of the hospital taking ownership of the hub pharmacy.

Because of all the steps that must be taken to meet state and federal requirements, a hub pharmacy would not likely come to fruition before April, 2009.

Satellite locations would likely be online six to eight months later. The cost of one medication dispensing machine is $50,000 to $75,000, though Shrum said there was funding available to assist with those costs.

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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.

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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.

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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.

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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.

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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.

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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."

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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.

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