GLFHC addresses NACHCA regarding telepharmacy

LAWRENCE — Greater Lawrence Family Health Center (GLFHC) recently addressed the National Association of Community Health Centers Annual Conference regarding telepharmacy and how the process has been implemented in the Lawrence-based community health center.

Patrick Grotton, MBA, chief information officer Diane Gatchell, R.Ph, director of pharmacy, and Timothy Hudd, Pharm.D., R.Ph., AE-C assistant professor of pharmacy practice, Massachusetts College of Pharmacy and Health Sciences, Boston, attended the four-day conference in New Orleans and were members of a panel addressing the topic of "Utilizing Telepharmacy Technology to Improve Access to Pharmaceutical Care in a Federally Qualified Health Center."

The three outlined the successes of using telepharmacy in an urban community health care setting.

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Nontraditional work schedules for pharmacists

Envision Telepharmacy

Description of the pharmacy.

Envision Telepharmacy is a Texas-licensed pharmacy that provides electronic supervision of pharmacy technician (EST) services for facilities with fewer than 101 beds, remote order-entry (ROE) services, and Pharm-Q, a Web-based system for order scanning and imaging. Services are provided 365 days per year and 24 hours per day. Within the parameters of a given state board’s rules and regulations, services can be scheduled to remotely provide any number of coverage hours on an ongoing or temporary basis. ROE services focus on one task, while EST services involve performing tasks for full-service operations. Pharm-Q products support local electronic order-scanning, ROE, and EST services for facilities and pharmacists who wish to provide or receive remote pharmacy service.

Most of the pharmacists at Envision are married women age 30–50 years with at least one dependent living at home. Twenty percent belong to a minority race, and 40% live in rural areas. The majority have other hospital pharmacy jobs as well.

Groups of three to nine pharmacists provide ROE services, with the majority of pharmacists working fewer than 20 hours per week. In all small and rural facilities currently using ROE services, the hours of coverage occur when there is no onsite pharmacist, typically evening hours and weekends. Service coverage occurs six or seven days each week and ranges from 47 to 92 hours weekly.

EST services are provided by groups of up to four pharmacists. Hours covered are typically daytime and weekday evenings. Service coverage ranges from one to seven days weekly and from 4 to 58 hours per week. Most pharmacists who cover EST services work more than 40 hours per week.

Serviced hospitals range from very small rural facilities to large urban facilities, and the level of onsite technology in place at the facilities varies enormously. For example, the smallest facility using EST services has 4 beds and no automation and lacks a computerized order-entry system. In contrast, a >350-bed ROE facility is heavily automated, utilizes pharmacy robotics, and has a completely paperless medication-order-processing system. For the purposes of this article, discussion will be limited to small (fewer than 101 beds) and rural hospitals.

Small hospitals currently receiving Envision’s ROE services range from a bed size of 29 to 100 with 1–11 onsite pharmacists. Onsite pharmacy operation is provided 40–93 hours weekly during weekdays. Directors of pharmacy in small hospitals often perform some or all of the pharmacy staffing duties in their departments. When staff is short, it is usually pharmacy leadership that must fill in for staffing vacancies. They are generally faced with a comparable number of administrative tasks as their counter-parts in larger facilities and have less support staff to accomplish them. When they fulfill staffing duties, their administrative work waits.

EST services are used in facilities with 4–40 beds and where consultant pharmacists are onsite fewer than five days per week or in facilities with a full-time pharmacist onsite but that wish to extend their hours of operation into the evenings or weekends. The smallest hospital receiving EST services is staffed with a consultant pharmacist who is present one day weekly, while the hospital with the largest staff receiving EST services has 1.5 pharmacist FTEs. Onsite pharmacist-directed operation is provided 4–40 hours weekly. Full pharmacy operation (onsite plus remote) is provided 8–58 hours weekly.

Creative schedules. For Envision Telepharmacy, the schedule is created by a central scheduler. Technology is used to collaborate, coordinate, confirm, and view shift coverage. Envision’s scheduling philosophy includes the idea that pharmacies should be staffed in a manner that the workload during a shift enables pharmacists to take care of all medication-related issues in a timely manner and that the onsite pharmacist can return to work without any leftover tasks. Consequently, more staff may be scheduled during higher-volume hours. Coverage requested by a hospital in addition to its usual coverage and any open shifts are filled by the pharmacists on a first-come, first- served basis.

As long as the coverage needs of the facility are met, almost any scheduling arrangement preferred by individual pharmacists and/or the pharmacist group covering the facility is acceptable. Staffing involves a great variety of shift lengths and intervals. Shifts range from 2 to 10 hours. The shortest workweek is 2.5 hours for a single pharmacist, and the longest workweek is 63 hours for pharmacists who work schedules of seven days on and seven days off.

There is also considerable variation in terms of cross-training between pharmacist groups for individual pharmacists or for cross-coverage of multiple facilities. Pharmacists may choose to work for one facility on some of their shifts and for another facility on other shifts or simply always work for a single facility.

Seventy-four percent of Envision pharmacists rated their satisfaction with their work as a 5 on a scale of 1 to 5, where 5 represents a rating of very satisfied. To date, no pharmacists have initiated termination of their working relationship with the program. Some pharmacists work from the pharmacy (Envision Telepharmacy), while others work remotely using the Envision website as a virtual site from which to provide services. Experienced hospital pharmacists who wish to reduce their time commitments in their careers find remote work a suitable practice. In addition, pharmacists who frequently relocate can continue to keep the same work schedule and work site.

Workload reports and errors are tracked for Envision pharmacists both during the start-up phase of services and on an ongoing basis. Error rates during the three-month start-up period range from 0.12% to 0.5%, and ongoing error rates range from 0.02% to 0.06%. For facilities willing to share their internal error rates and turnaround time reports, the Envision Telepharmacy’s error rate and turnaround time are the same as or, more frequently, below those of the onsite pharmacists. Pharmacists periodically receive reports on their workload volumes and turnaround times along with comparative data for the facility. The high-tech workplace gives pharmacists with interests in information technology an opportunity to work with cutting-edge technology. Ease of access through a Web-based electronic order-management system allows for communication with the nursing or pharmacy technician on

duty at the serviced facility as well as the returning onsite pharmacy department staff. Technology offers pharmacists an opportunity to experience work in a specialty practice area to which they might not otherwise have geographic access.

Scheduling philosophy varies regarding onsite and remote staffing among the serviced hospitals. Some facilities use remote services due to lack of availability of a pharmacist in their area, some regard remote staffing as a way to provide partial or full services during lower-volume hours at a reduced cost, and some wish to extend hours of service by using remote pharmacists. Hospitals may utilize remote services to supplement their onsite staffing in order to free up time for the onsite pharmacists to provide clinical or administrative duties, or simply to take the order-entry burden off of the onsite staff during high-volume hours or periods of pharmacist shortages. Even if the pharmacy leader does not routinely staff the pharmacy, remote pharmacists can be used to staff a pharmacy department during the temporary pharmacist shortage that may occur during holidays, vacations, continuing-education attendance, sick time, and family and medical leave.

Rural hospitals use remote services to comply with regulatory or accreditation agencies, as well as to increase patient safety with the use of experienced hospital pharmacists and increased prospective review of medication-related processes. To more successfully recruit and retain onsite pharmacists in their pharmacy departments, rural hospitals use remote services with the goals of eliminating or greatly reducing the volume of after-hours calls to the hospital’s on-call pharmacist and allowing the onsite pharmacist to return to the department with work caught up and documentation intact on activities occurring since his or her departure.

The most common scheduling philosophy adopted by facilities desiring EST services is that patient safety is enhanced when the medication-related processes of the hospital are prospectively reviewed and controlled by a remote pharmacist rather than by nursing or unsupervised pharmacy technicians coupled with retrospective review by an onsite pharmacist. The philosophy often encompasses the belief that consultant pharmacist time spent on retrospective review of supportive personnel can be eliminated or greatly reduced and that this time can be spent on departmental management and administration, regulatory and quality processes, staff education, and cost-saving clinical activities. The cost of EST services is reliably less than the cost of an onsite pharmacist. For facilities with a full-time pharmacist, this staffing model can be most cost-effective during evening or weekend hours or to fill needs during a short shift. For a facility with less than a full-time on-site pharmacist primarily providing retrospective review of limited pharmacy activities (order review, medication removal from the pharmacy by non-pharmacists), the service can affordably shift the activities toward prospective review and full pharmacy services.

Challenges. Due to the nature of remote work and the hours the pharmacists typically provide service, administrative staff are lacking in frequent face-to-face interactions with pharmacists. As well, pharmacists who work together may not have even met face-to-face. For administrative staff, excellent telephone and electronic communication skills are essential to successful operation of the service and in building a relationship with the pharmacists. Communication systems are in place for the pharmacists both to communicate facility-specific information and to collaborate with one another while on duty. Camaraderie and team building are evidenced through use of those systems by the pharmacists and the rapid filling of open shifts.

Scheduling of the pharmacist staff is complex. The large variation in preferences for shift lengths and the number of pharmacists and facilities, along with numerous licensure and split-shift combinations, present an ongoing challenge for the central scheduler. Changes to schedules or requests for additional hours with short notice are difficult to fill. Electronic communication systems are in place for schedule posting, viewing, confirmation, and review.

Not all pharmacists are well suited to provide remote services. Pharmacists who are self-motivated, like independent work, and have the ability to learn about and become comfortable with the capabilities and limitations afforded by computer technology can thrive in this practice setting.

EST service is not, nor is it designed to be, as efficient as an onsite pharmacist. An adequate technician staff, as well as on-site pharmacist and administrative support, is essential to the success of this practice model. Attempts to utilize this service in a busy environment are self-limiting, since facilities whose medication volume warrants a full-time pharmacist over long periods of time simply cannot be served adequately by this practice model. Although satisfaction surveys have not been distributed, feedback received from nursing is consistently positive or neutral, with the following exception: in facilities with rapid onsite dispensing times (<15 minutes) for medications that must be supplied from the pharmacy, the relative wait time for medication to be delivered to the floor is increased. For example, in a small facility, a delivery time of 30 minutes for a new medication ordered for a patient before discharge may seem unacceptable to a nurse, even though the pharmacy may be feeling the pressures of being in the first hour of operation for the day and of the morning medication pass due within the hour.

Discussion

These case studies present several examples of how unique and alternative work schedules can be integrated into the day-to-day operations of health-system pharmacies. The most recent ASHP staffing survey found pharmacist and technician turnover rates of 9% and 12.4%, respectively, and 48% of respondents were considering nontraditional staffing solutions in an effort to recruit and retain staff.7 While no two hospitals or pharmacy practice environments are exactly the same, it is up to each pharmacy practice manager through collaboration with the staff to come up with solutions that can meet the needs of the changing pharmacy work force.


Conclusion

Compressed workweeks, job-sharing, and team scheduling were the most common types of alternative work schedules implemented at three different institutions.

References

1. ASHP Task Force on Pharmacy’s Changing Demographics. Report of the Task Force on Pharmacy’s Changing Demographics. Am J Health-Syst Pharm. 2007; 64:1311-9.

2. Mott DA, Doucette WR, Gaither CA et al. Pharmacist participation in the workforce: 1990, 2000, and 2004. J Am Pharm Assoc. 2006; 46:322-30.

3. American Society of Health-System Pharmacists. ASHP long-range vision for the pharmacy work force in hospitals and health systems: ensuring the best use of medicines in hospitals and health systems. Am J Health-Syst Pharm. 2007; 64:1320- 30.

4. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2005. Am J HealthSyst Pharm. 2006; 63:327-45.

5. Deal JJ. Retiring the generation gap: how employees young and old can find common ground. San Francisco: Josey-Bass; 2007:144-71.

6. Proctor C. Flex appeal: it’s all in the planning . www.ama-assn.org/ amednews/2007/08/13/bisa0813.htm (accessed 2007 Oct 13).

7. Schecklehoff DJ, Bush C. 2006 ASHP pharmacy staffing survey results. www.ashp. org/s_ashp/docs/files/StaffSurvey2006.pdf (accessed 2008 Aug 20).

Source

Telepharmacy service instituted in Barry's Bay hospital

St. Francis Memorial Hospital in Barry’s Bay has solved its pharmacist problem by using a telepharmacy service. Kevin McDonald, manager of the Hospital Pharmacy Telepharmacy program for the North West Company, and pharmacist Monique Yurkiw work with Joan Kuiack, Director of Patient Care Services at the hospital and (seated) Joan Sullivan, pharmacy technician to test the system. Heather Kendall

The shortage of health care professionals across the province has made it difficult for small rural hospitals to offer the services needed. For the past 18 months, for example, St. Francis Memorial Hospital in Barry’s Bay has been trying to find a pharmacist, without luck.

But it has now solved the problem by connecting with Northern Pharmacy Limited (a division of The North West Company), which offers telepharmacy services.

“A small hospital can safely operate a medication storage and distribution system for their patients under the management of a registered nurse,” says Joan Kuiack, Director of Patient Care Services. “However, the addition of a pharmacist offers an enhanced quality of care to our patients.”

A pharmacist has the expertise to look at the whole patient, his or her disease and relate the effectiveness of the medication they are receiving to their progress, she adds.

The hospital first contacted Kevin McDonald, manager of the hospital pharmacy telepharmacy program at Northern Pharmacy, about a year ago, but decided to try to organize a partnership with Renfrew Victoria Hospital for services of a pharmacist.

“We advertised nation-wide, but couldn’t find a pharmacist and so we went back to Kevin,” says Kuiack.

The North West Company is based out of Winnipeg; the Northern Pharmacy provides similar services to hospitals in areas such as Deep River, Cornwall and Moose Factory. McDonald, who hails from Deep River, initiated the telepharmacy project in 2004.

“A hospital pharmacist is very different from a retail pharmacist,” he says. “In smaller hospitals, there is not enough work to employ a pharmacist full-time, so it’s hard to attract them. We fill that need.”

Monique Yurkiw, a pharmacist with the company since July, will look after St. Francis Memorial. She and McDonald were at the hospital last week to test the system.

“It’s good,” she says. “We’re set to go.”

When a patient is admitted to hospital, order forms for medications are written up and the pharmacist technician enters the information into the patient profile on the computer, and then prints up labels and dispenses the drugs, which go to the nursing unit. Under the new system, the order forms will be scanned to Yurkiw. She will verify the order, ensure the medication, dosage and strength are appropriate; she can watch for possible drug interactions, misinterpreted drugs, or duplicates.

“It’s really a clinical review,” says Darlene Sernoskie, the hospital’s director of operations. “She can also look at lab results online. If there is an issue, she can contact the physician or nursing staff.”

Yurkiw will work from a computer terminal in her home office in Kemptville and will have direct contact with the pharmacy technician working in the St. Francis pharmacy. She will sit on the pharmacy and therapeutics committee and expects to visit the hospital once a month. When she comes to Barry’s Bay, she will attend meetings, review the pharmacy stock and check batch refills for long-term care patients. She’s excited to be connected to this hospital.

“I do some other locations, but this is my site,” she says. “I like the sense of belonging, of being a part of the team.”

“Monique fits in well,” says Sernoskie. “This is a proven system that addresses the national shortage of pharmacists and allows us to enhance the quality of care we offer to our patients. We’re excited.”

The physicians are also happy to have Yurkiw on board.

“The pharmacist is an important support to the physicians and plays a vital role on the health care team,” says Dr. Denise Coulas. “There is no doubt that the right combination of medications is a large part of the treatment plan while in hospital. A pharmacist works with the physicians and staff to provide effective care and a safe transition after discharge.”

Telepharmacy is a first for reservation

TWIN BUTTES A ribbon-cutting ceremony for the opening of the Three Affiliated Tribes telepharmacy will be held Wednesday at 10 a.m. in the Minne-Tohe Health Center's satellite clinic in Twin Buttes.

The opening of the telepharmacy is a first for the Fort Berthold Reservation.

There will be a prayer offered by tribal elder Edwin Benson and an open house at the telepharmacy from 10 a.m. to 2 p.m.

A traditional meal will be served at noon in the Twin Buttes Memorial Building followed by a health fair.

"This is a historic day for the people of the Mandan, Hidatsa and Arikara Nation. The telepharmacy project is a major step toward improving the quality of patient care across the Fort Berthold Reservation," said Stella Berquist, chief executive officer of the Three Affiliated Tribes Minne-Tohe Health Center at New Town. "Health care professional of the Three Affiliated Tribes have been working diligently over the past few months to make this dream a reality."

Here's how telepharmacy works:

Through the use of state-of-the-art telecommunications technology, pharmacists are able to provide pharmaceutical care to patients at a distance. A licensed pharmacist at a central pharmacy site supervises a pharmacy technician at a remote telepharmacy site through the use of video conferencing technology. The technician then prepares the prescription drug for dispensing by the pharmacist.

The Twin Buttes clinic is the main office of the telepharmacy project on Fort Berthold. Other pharmacies will be opening in Mandaree, White Shield and Parshall.

Donna Bieri, a pharmacist from Dodge who has nearly five years of experience working with telepharmacy, will be working on a permanent basis at the Twin Buttes telepharmacy. She will travel to each of the other sites at least once a month.

The pharmacies in Mandaree, White Shield and Parshall are expected to open in about four to six weeks.

The telepharmacy project is a project of the Minne-Tohe Health Center, tribal business council and Twin Buttes Segment.

Source
This seems to have been summarized and distributed to limited AP press outlets: here & here

Treating sick kids has become easier

Telemedicine program lets nurses connect ill students with health providers

Michael Patrick
Patricia Hess, a nurse, is working at Seymour Middle School under an agreement between Sevier County Schools and Cherokee Health Systems to provide medical services to students. The telemedicine program is linked via two-way camera to a physician’s assistant in Knoxville for instant evaluation of the patient.

As the Seymour Middle School student sat in front of the large monitor, his image appeared on the screen.

Using special equipment, the school nurse checked the seventh-grader's ears and throat while a two-way camera simultaneously transmitted real-time video 15 miles away to the medical offices of Cherokee Health System in Knoxville.

"The student has been seen. He is able to stay in school, and the parent doesn't have to leave work," said Olga Eisenhower, one of two Cherokee Health nurse practitioners hired in August for a new telemedicine program launched this month in partnership with Sevier County schools.

Available in 17 Sevier County elementary and middle schools serving approximately 9,700 students, the Internet-based program provides on-site medical services using state-of-the-art technology to connect sick students with a medical provider who can examine, diagnose, treat and monitor them.

Lab testing for strep throat and influenza will also soon be available at each school.

It's a project that school officials hope will promote healthier and happier students and ultimately improve attendance and graduation rates.

"If we can take care of a child's basic well-being, then we can not only maintain academic excellence but improve upon it," said Don Best, coordinator of school health.

Best and Director of Schools Jack Parton turned to Cherokee Health, a safety-net provider serving mostly low-income residents and the uninsured with a decade of experience in telepsychiatry. Cherokee Health is also in the process of piloting a telepharmacy program.

It uses teleconferencing equipment and high-speed telephone lines to allow the clinician and patient to see and speak to each other as if they were in the same room.

The latest project, estimated at $1 million, is an investment in equipment and staff, with Sevier County schools and Cherokee Health splitting the cost. They expect to recover some expenses through private insurance claims and grants.

"It's about access to care. This project knocks down some of those financial, transportation and time barriers," said Joel Hornberger, Cherokee Health chief operating officer.

More than 50 percent of the students in Sevier County schools are on free and reduced lunch, and many parents work in the service industry. That means every hour away from work is an hour of not getting paid, Best said.

Schools such as Caten's Chapel, Wearwood and Pittman Center elementary schools aren't located in close proximity to health care providers which also makes access to care difficult. And some parents, he added, don't always follow the recommendation of the school nurse.

"We are not trying to take patients away from primary care physicians. We are trying to complement and be an adjunct to them," Eisenhower said.

Of those students who will visit the school nurse, Best said he expects about 20-25 percent will require telemedicine. Parents must sign a registration form in order for their child to take advantage of the program.

Standard deductibles apply. Those without health insurance pay $5 as well as a minimal charge for any lab services that may be required.

"I think it's groundbreaking," Best said. "I was very surprised with what you could do with telemedicine."

Business writer Carly Harrington may be reached at 865-342-6317.

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Telemedicine Lobbyists Meet with North Dakota State Legislators

An excerpt from Senator Tom Seymour's blog:

Mr. Howard C. Anderson, Executive Director, State
Board of Pharmacy, provided information regarding
health information technology. He said North Dakota
State University has received a federal grant relating
to telepharmacy, and the university has awarded a
contract to Catholic Health Initiatives to implement a
telepharmacy program. He said the telepharmacy
program consists of a central site where pharmacists
and technicians receive information regarding orders
for drugs from the prescribing physicians in rural
health care facilities. He said the orders are reviewed
by the pharmacist using the specific patient's
information. He said the project would function more
effectively if the pharmacist could access the patient's
medical record at the facility and enter the
recommendations or approval directly into the record.
A copy of the information presented is on file in the
Legislative Council office.
Ms. Kimber Wraalstad, President and CEO,
Presentation Medical Center, Rolla, provided
information regarding health information technology.
She said health information technology is important to
increasing the quality of patient care. She said health
information technology applications are expensive to
implement and maintain. She said several North
Dakota critical access hospitals in the state are
experiencing operating losses and are not able to
purchase health information technology applications.
She said hospitals in Bottineau, Rolla, and Stanley are
working together on health information technology
projects and 10 health care facilities in the northwest
part of the state have formed the Northwest Alliance
for Information Technology Projects to research and
implement health information technology applications.
A copy of the information presented is on file in the
Legislative Council office.
In response to a question from Senator
Christmann, Ms. Wraalstad said hospitals rely more
on each other for assistance with health information
technology because the North Dakota Healthcare
Association and the North Dakota Long Term Care
Association do not have expertise in health
information technology.

Telepharmacy Project Expands

It's been six years since the first telepharmacy in Texas opened up in the small town of Turkey, but only a few more have popped up since then, according to Texas Tech University, which says it is looking at ways to increase interest in telepharmacies.

Telepharmacies have real drug stores and allow customers to talk to a real person connected to a pharmacist by the Internet.

Don Turner, who runs the pharmacy in Turkey, says 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.

Debbie Voyles, director of telemedicine at Texas Tech, says the school is now watching a telepharmacy program in North Dakota that started with 10 volunteer sites in 2002 and has grown to 67 locations.

Voyles says she's hoping to learn from North Dakota's success.

Texas is among at least nine states that have changed laws to allow for remote pharmacies.

Source

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.

Source

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.

Source

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