Texas Posts Grant Notice

The Texas Office of Rural Community Affairs (ORCA) has posted information on the Texas Rural Health Technology Grants for FY 2009. This grant program supports the development of clinical systems and capital equipment for Critical Access Hospitals. ORCA seeks projects that will address at least one of the program goals and at least one of the objectives.

The goals are to expand access to care in rural areas, improve the quality of care and patient safety, provide more efficiency in delivering, coordinating, and integrating healthcare, and improve hospital finances and sustainability.

The program objectives are to implement HIT, EHRs, telemedicine or telepharmacy applications, expand access to health services, reduce health disparities, improve workflow and productivity, enhance hospital viability, and provide for cost efficiencies.

Specifically, the funds are to provide EHRs, physician ordered entry systems, bar-coding systems, data or laboratory information systems, IT/MIS applications, telehealth, telemedicine, telepharmacy, or tele-education. Funds can be used for medical laboratory imaging technologies or services, to improve hospital performance, and produce quality improvement systems or tools.

Only Critical Access Hospitals in Texas that have not been awarded the ORCA Technology Grant in FY 2008 are eligible to apply for the FY 2009 grants. The grants are supported by the Medicare Rural Hospital Flexibility Grant Program and will be awarded by HRSA. A total of $150,000 is available for this program and grants will not exceed $30,000 per grantee. The deadline for the grant applications is December 5, 2008.

For more information, go to http://www.orca.state.tx.us/, or call 1-800-544-2042, or 1-512-936-6701.

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Melissa Memorial staff gets high marks in state surveys

By April Peregoy

Melissa Memorial Hospital was the subject of three surveys that took place during the month of September. Reporting at the East Phillips County Hospital Board meeting Tuesday, Sept. 23, administrator John Ayoub was happy to announce the hospital performed very well on all three surveys.
The first was a state survey conducted to make sure the hospital was meeting all the conditions of participation. Ayoub said the survey went well, and he gave staff members a lot of credit for their hard work and cooperation.
Only three minor deficiencies were found, all of which had to do with administration and paperwork areas and not with healthcare procedures.
The first revolved around conflicting policies caused by outdated paperwork that had not yet been upgraded. Ayoub said the hospital is working on bringing all their policies up-to-date. The hospital was also told the Chief of Staff needs to sign off on each department policy.
MMH was also marked down for not currently having an outreach site for pharmaceuticals. This is due to the recent cancelation of the hospital board's contract with Banner Health. The situation is only temporary however, as the board is working on finalizing a contract with Poudre Valley Hospital of Fort Collins to provide telepharmacy services.
Ayoub also pointed out MMH is not the only hospital in this situation, as five other hospitals in northeast Colorado are affected as well.
A follow-up Life Safety Survey was also conducted over the past month. This survey is more facility-focused and is done to make sure all emergency equipment such as emergency doors, fire alarms and fire extinguishers are working properly.
The survey was actually conducted in February and a number of things were found that needed to be corrected. Checking back in to make sure MMH had followed up on these corrections, the September survey found the problems had been fixed.
The final survey was the State Vaccine For Children Survey, which was conducted in the Family Practice Clinic. It is done to make sure the clinic is performing and storing vaccinations properly. Again, Ayoub reported the clinic performed well on the survey.

Staff transitioning to new
electronic record system
The hospital is now beginning the process of switching to an electronic medical records system. According to Ayoub, the first phase of the transition began on Oct. 1 and involves the implementation of practice management software.
After a 90-day training cycle with the new software, the hospital will transition into the electronic record system in early 2009.
Ayoub said the system will greatly benefit patients because their medical charts can be accessed right away. It will also allow the hospital to do its own billing rather than rely on another company to do it for them.
In August, a new documentation form was implemented to help the staff transition into the new system. Chief of staff Dr. Dennis Jelden told the board Tuesday night the new forms have been a big help and the staff is adjusting well to them.
Another computer system purchase request the board is considering is for a claim scrubber. This is a computer application that detects errors made in a claim before it is sent to an insurance company. The purpose is to reduce claim denials due to technical mistakes.
Ayoub said the application could cost as much as $30,000, but would benefit the hospital in the end by improving the efficiency of the payment process with the insurance companies.

Special meeting scheduled
EPCHD will hold a special meeting Tuesday, Oct. 7 to discuss and approve changes recently made to its Ends Statement. The board felt the policy was too important to make a quick decision on it, and wanted some time for review.
A public hearing on the hospital board's budget for 2009 will take place at its next regular meeting, which is scheduled for Tuesday, Oct. 28.

Other business
In other business Sept. 23, the EPCHD board:
-toured the laboratory and heard a general report from lab director Deb Taytum on the department's services and staff.
-was informed Tuesday night Dr. Scott J. Hadley, who treats patients needing emergency dental care, will no longer be available to the hospital. The board is now searching for another dentist in the area to provide this service.
-approved a lease with Harry Sprague to farm the 20-acre empty lot behind the hospital. Ayoub said this was done to save time and money on mowing and to be respectful of the surrounding neighborhood.
-reaffirmed the hospital's policy that EMS attention will be given to all calls that come in, regardless of whether the emergency site is located within district boundaries.
-was informed the hospital had its first on-site helicoptor landing. Ayoub stated some complications did occur, but that it was a good learning experience and next time the staff will be even better prepared.
-canceled its contract with the company that provides the hospital with its Spanish-language phone line. A new contract has already been signed with a different company.
-signed a contract to upgrade and improve the hospital's website. Once the initial upgrades have been made, Ayoub said it is his desire to have a staff member trained to maintain the website.
-was notified the hospital received a $9,000 SHIP grant. MMH is also seeking an emergency preparedness grant.
-heard a presentation from the MMH Foundation that the board is expected to close on a loan in October for the donor recognition wall and MMH history wall.
-approved a bid from EIDE Bailey to provide the hospital's auditing services.
-heard a report from FBLA member Samantha Redfern on the progress being made on the clock tower project. The report showed the club still has $17,000 to raise for the project.
-held a 30-minute executive session to discuss the sale of the old building.

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Telepharmacy owes a lot to Sen. Dorgan

As dean of North Dakota State University’s pharmacy program and director of the North Dakota Telepharmacy Project, I was pleased to see the recent AP article published in The Forum on our telepharmacy program. This program is the first of its kind in the country, and it shows what North Dakota is capable of accomplishing when academia works together with rural communities and private businesses to achieve a common goal.

The purpose of the North Dakota Telepharmacy Project is to restore, retain or establish pharmacy services in medically underserved rural communities of North Dakota through the use of telepharmacy technology. Through this program, a licensed pharmacist at a central pharmacy site supervises a registered pharmacy technician at a remote telepharmacy site in the processing of prescriptions for patients. Currently 67 pharmacies are involved in the project – 22 central pharmacy sites and 45 remote telepharmacy sites. Of the 67 pharmacies involved, 44 are retail pharmacies and 23 are hospital pharmacies.

Twenty-nine (55 percent) of North Dakota’s 53 counties are involved in the project and two in Minnesota. Approximately 40,000 rural residents have had pharmacy services restored, retained or established through the North Dakota Telepharmacy Project since its inception in 2002. The project has restored valuable access to health care in remote medically underserved areas of the state and has added more than $12.5 million annually in economic development to the local rural economy.

The only thing missing in this article was acknowledgment of the important role Sen. Byron Dorgan, D-N.D., played in making this program possible. Through Dorgan’s efforts on the Senate Appropriations Committee, he helped provide more than $3.3 million in federal support to NDSU to ensure that this program became a reality.

I can honesty say that North Dakota would not have this nation-leading telepharmacy program today without Dorgan’s help. Considering the impact this program has had locally, regionally and nationally, I believe Dorgan deserves some credit and recognition for his efforts regarding this terrific program.

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Info on Author: Charles D. Peterson, Pharm.D., Dean, Professor, and Principal Investigator
North Dakota State University College of Pharmacy, Nursing, and Allied Sciences
Info on Dorgan: http://www.votesmart.org/bio.php?can_id=53332

Pharmacy Students Working Toward “Closing the Gap”

Excerpt:

Finally, the event ended after a “Call to Action” panel moderated by Roshini Epasinghe, consisting of three student pharmacists from the UCSF School of Pharmacy: Serena Huntington, Megan McCurdy and Martha Prieto. Advocates for the cause, these three student pharmacists spoke to their experiences and involvements with serving the underserved. Huntington focused on her current Schweitzer Fellowship, which is aimed at improving health outcomes through preventative medicine.

McCurdy shared her experiences in serving the underserved internationally in Mexico this past summer, where she was able to shadow physicians and learn Spanish for a period of one month. Prieto spoke about her current involvement with telepharmacy and how her fluency in Spanish has helped her to serve the underserved Spanish-speaking populations of San Francisco.

The event concluded with a brief speech given by Epasinghe, advising fellow student pharmacists on career development and matters related to networking. The sponsoring organizations hope to make “Closing the Gap” an annual event, so be sure to support them in advocating for the underserved at next year’s event.

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Telepharmacy and ePharmacy: Siamese or discrete?

There's a new paper out in the International Journal of Healthcare Technology and Management addressing Telepharmacy and e-pharmacies.

State pharmacy board meeting Wednesday in Rothschild

The Wisconsin Department of Regulation & Licensing will hold its professional pharmacy examining board meeting starting at 9 a.m. Wednesday at the Cedar Creek Lodge, 805 Creske Ave., Rothschild.

The board is part of the state’s Department of Regulation & Licensing, which licenses and regulates 128 different types of credentials in 57 professional fields, including pharmacists’ licenses. It issues nearly 50,000 new credentials and it renews approximately 350,000 credentials every two years.

“This is a great opportunity for pharmacists in central Wisconsin, other health professionals and the general public to see the work of the Pharmacy Board first hand,” said Celia Jackson, the department’s secretary. “Holding this type of meeting outside Madison is part of a broader effort to make the work of licensing and regulatory boards more visible and accessible to the people of the state.”

Agenda items include discussing various issues related to filling prescriptions as well as a closed session to deliberate on possible disciplinary actions.

Following the meeting, participants are invited to travel a short distance to Marshfield Clinic Weston Center to observe a demonstration of a remote dispensing and telepharmacy operation.

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Houston Cronicle / AP Story comments

There were a number of comments around the web on the widely mirrored Associated Press story on the North Dakota Telepharmacy Project as well as the Telemedicine project at Texas Tech University. See the previous post for that story.
Summary1
Blog Post

Telepharmacy project expands across country

ARTHUR, N.D. — The days of walking down to the general store for prescription drugs are returning to rural America, thanks to a virtual pharmacy system that has been tested on the frozen prairie.

As recently as three years ago, many elderly residents in this area of southeastern North Dakota were forced to order their medications by mail. Now, customers have a real drug store and can talk to a real person who's connected to a pharmacist by the Internet.

"It's perfect," said Jim Williams, a longtime Arthur resident. "You can walk down there and it's done in a few minutes."

North Dakota lawmakers opened the door for the telepharmacy project by passing legislation in 2001, after dozens of rural pharmacies went out of business. The project began with 10 volunteer sites in 2002 and has grown to 67 locations.

The idea may be catching on in other places.

States that have changed laws to allow for remote pharmacies include Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont and Wyoming, along with the District of Columbia. More are on the way, the head of North Dakota's project said.

"We get calls every day from other states," said Ann Rathke, director of telepharmacy at North Dakota State University in Fargo. "A lot of states have used or have adopted in some way our rules, because they were out there."

Charles Peterson, dean of pharmacy at NDSU, said the rest of the country has been "watching and waiting" to see how the North Dakota project worked.

"Every state is struggling with, the most part, the same issues," he said. "Access to health care in a rural setting is a problem for everyone. We have shown that this is a solution."

Most telepharmacies are staffed with registered pharmacy technicians, who usually need about two years of schooling and earn about $15 an hour in North Dakota. Some registered nurses also have been trained for the job.

"You don't have the expense of a regular pharmacist," said Katie E. Thompson, a registered pharmacist who lives near Page. "That's the point of a telepharmacy."

The pharmacy technicians use remote cameras to show pharmacists the original signed prescription, computer-generated label, stock bottle where the pills are stored and the bottle the patient will take home. Once the prescription is approved, patients have a mandatory private consultation with pharmacists through real-time video and audio.

"We can do most of the things the pharmacists do except give professional advice," said Jennifer Joyce, the pharmacy technician in Arthur.

She can offer guidance on other matters, such as the weather, crop conditions, family events and high school basketball. Joyce knows all of her patients on a first-name basis. Many of them are there for more than just a bottle of pills.

"When they're sick, sometimes they just want people to listen to them," she said.

Rathke said it costs about $18,000 to set up a site in North Dakota, including equipment, installation and one year of Internet service. Telepharmacies pay an annual licensing fee of $175.

"It's not rocket science, and it doesn't cost a tremendous amount of money," Rathke said.

It does take some political will, Peterson said. In most cases pharmacy has more laws and rules than any other area of health care and many states are unwilling to make modifications or adjustments, he said.

"Finally, those other states that haven't in some cases been willing to talk about it, willing to even look at it, are being forced to look at it because North Dakota has proven this thing," Peterson said.

It hasn't been proven in every state.

The first telepharmacy in Texas opened in 2002 in the town of Turkey and has gained in popularity. But only a few more sites in Texas have popped up since then, said Debbie Voyles, director of telemedicine at Texas Tech University.

"Where there are no pharmacies, there are no doctors," she said. "Patients have to travel to see the doctors, so it's no big deal to them to have to pick up the prescriptions."

The Texas Tech pharmacy school is looking at ways to increase interest and is hoping to learn from North Dakota's success, Voyles said.

Don Turner, who runs the pharmacy in Turkey, said his clients are mostly elderly people who don't have access to transportation. The nearest pharmacist to the town of 400 people is about 50 miles away.

"It's a great thing for Turkey," Turner said. "I think it's just a matter of time for other small towns."

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Automated drug dispensers become more popular in Fargo-Moorhead

FARGO – A screaming child with a late-night earache will make any parent’s skin crawl.

Not only may the pain trigger a trip to the emergency room, but the chances of getting needed medications before morning are often nil.

The InstyMeds machine at Innovis Health in Fargo dispenses prescription medicine much like a vending machine. (David Samson/The Forum)

Hospitals can’t stop ear infections, but several are addressing the prescription problem by installing ATM-style machines that dispense drugs.

These InstyMeds systems hold dozens of commonly prescribed medications, giving patients access to drugs after retail pharmacies close or saving them another trip when they’re not feeling well.

“For us, it was really about offering our patients the convenience factor,” says Todd Forktel, an administrator at Innovis Health. The Fargo hospital installed its system in April.

InstyMeds works much like an ATM machine, automatic car wash or any other type of automated kiosk.

A physician sends the prescription to InstyMeds via a computer. The patient receives a code that he or she punches into the machine to retrieve the medication, which is labeled and comes with instructions.

The system bills the patient’s insurance. Co-pays are accepted via credit card, debit card or cash. If problems or questions arise, patients can use an attached phone to reach an InstyMeds pharmacist.

“They’re so easy to use,” says Natalie Rund, emergency department nurse manager at Lake Region Healthcare in Fergus Falls, Minn. “I tell patients, if they can use an ATM machine, they can use this.”

Each hospital determines which drugs the machine will dispense. Limited supplies of antibiotics, anti-nausea drugs and pain relievers are among the most common.

InstyMeds doesn’t allow refills and most hospitals avoid filling it with medications designed for chronic conditions like high blood pressure.

“We’re not trying to compete with the pharmacists,” says Chris Harff, CEO at MeritCare Thief River Falls, Minn. “We just want to help patients who like the convenience.”

The technology fills a gap in communities that don’t have pharmacists ready to fill prescriptions 24 hours a day, seven days a week. For example, there’s no retail pharmacy open in the Fargo-Moorhead area after 10 p.m., Forktel says.

MeritCare in Fargo has a pharmacy open all the time for its emergency room patients, but not for the general public, says spokeswoman Carrie Haug.

MeritCare Thief River Falls installed its InstyMeds machine several years ago, Harff says.

“Patients love it,” she says. “If you’re sick enough to go to the emergency room, you don’t want to hang out at the pharmacy. They’re done when they leave here.”

Not everybody is fond of the technology. The North Dakota Board of Pharmacy discourages the use of dispensing machines like InstyMeds, says Howard Anderson, its executive director.

“Research has shown that the best scenario is for a patient to get information and counseling from a pharmacist,” he says. “We recommend physicians give the patient a starter supply of drugs and a prescription so a pharmacist reviews it as soon as possible.”

North Dakota has a telepharmacy program that allows patients to consult with a pharmacist even if one isn’t in the community, Anderson says.

“We’re not telling physicians they can’t dispense medications, but we’d prefer they look at this (telepharmacy) model,” he says.

Emergency rooms and urgent cares with automated dispensers still allow patients to get their prescriptions filled at a pharmacy. But patients who are comfortable getting cash from ATMs and checking in on airline flights via computer terminals have few qualms about doing the same for their prescriptions.

“In the evenings, everyone’s wondering how they’ll get medications,” says Dr. John Baugh, who works in the emergency room at Innovis Health.

Physicians, too, wonder if they’re giving patients enough drugs to last until they can get to a pharmacy, he says.

The popularity of InstyMeds has increased since Innovis installed its system in April. The first month, it dispensed 249 prescriptions. During three weeks in July, it dispensed 418 before running out of medications.

Baugh say, “Most patients seem to want to use it so they can get their medications and go home.”

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Dialing Up Medication Safety

When Lewistown (Pa.) Hospital decided to implement an electronic medication administration record, hospital executives decided patient safety was also going to get an upgrade.

The 139-bed hospital's in-house pharmacy was only open 14 hours a day. During that time an on-staff pharmacist would review all new prescription orders. Drug orders placed during off hours, however, would be reviewed and filled by nurses, who are well-versed in potential adverse drug interactions but lack the in-depth knowledge of pharmacists, says Richard Stomackin, director of the inpatient pharmacy at Lewistown.

So when the hospital deployed the electronic medication record, Stomackin also wanted to have 24-hour pharmacist review of drug orders. His first inclination was to hire two new pharmacists, but considering each position would require a six-figure salary plus benefits, finding two new staff members wasn't an attractive financial option. He also thought it would be difficult to attract qualified candidates to Lewistown's central Pennsylvania location.

Stomackin found another option in Rxe-source, a telepharmacy service from Cardinal Health, Dublin, Ohio. The telepharmacy enables a hospital to supplement its onsite pharmacy services by connecting to telepharmacists working at remote locations.

The telepharmacists receive faxed or phone drug orders, then evaluate a patient's medication profile, review necessary lab values, enter the medication into the patient profile, check for possible interactions and authorize orders for administration.

Lewistown began using Rxe-source in September 2005. The hospital's on-site pharmacy is staffed from 7 a.m. to 9 p.m. weekdays and 8 a.m. to 6 p.m. on weekends. When the on-site pharmacists leave, all calls and faxes are routed to the telepharmacy in Ohio.

Lewistown nurses typically fax the orders to the telepharmacy. The telepharmacists then connect via a secure Internet connection to Lewistown's medication administration record to check the patient's previous medications and medical conditions. The telepharmacist reviews the current order and calls a nurse or physician at Lewistown if any revisions are necessary.

After the telepharmacist approves the order, either via fax or phone, the nurse then retrieves the medication from cabinets that are stocked during the day with drugs the caregivers will need during the night shifts. If the medication is not available in a cart and needs to be administered immediately, a staff pharmacist is asked to come to the facility and fill the order.

Cardinal Health charges Lewistown a monthly fee based on the medication order volume during Rxe-source's hours of coverage. Lewistown declined to provide details about costs.

Initial setup of the telepharmacy was challenging, Stomackin says. Staff pharmacists had to fill out a 26-page survey that asked questions about the hospitals policies and procedures, as well as what drug substitutions the hospital allows and the facility's potential order volume. Lewistown also had to standardize order sets so the telepharmacist could follow standard protocols.

In addition, Lewistown nurses have had some run-ins with the telepharmacists, Stomackin says. "Nurses complain that the telepharmacy guys are stricter than we are," he says. "If you tell the telepharmacy this is hospital policy they adhere to it. This is different when we're here during the day when we have some flexibility to work things out."

Stomackin adds that because the pharmacists know the physicians and the personalities involved it's easier for them to make exceptions to hospital policy, whereas telepharmacists will stick to the rules.

But Stomackin believes the telepharmacy service has helped increase patient safety at Lewistown. "Any time you have an additional check you improve patient safety," he says. "It's one more safeguard to make sure that the patient is getting the right drug."

Another benefit of the service: by enabling the hospital to have 24-hour pharmacy coverage, it helped Lewistown improve its score during a recent review by the Joint Commission on Accreditation of Healthcare Organizations, Stomackin adds.

Pharmacists increasingly are in demand, and it's likely the need for telepharmacy services will increase, says Paul Johnston, senior consultant at Healthia Consulting, a Minneapolis-based health care I.T. consulting firm. The U.S. Department of Labor is predicting a shortfall of 157,000 pharmacists by 2020.

Rural areas that have chronic problems hiring full-time pharmacists are turning to telepharmacies to improve safety around the medication administration process, Johnston says.

"In an inpatient setting it's critical to have a pharmacist involved," he says. "The telepharmacist can check for harmful interaction, review current medications and perform dosage correction."

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