Pharmacy moves into the telehealth world

By:Fred Gebhart

Drug Topics Supplements

More and more pharmacists are practicing telepharmacy—that is, using technology to provide pharmacy services to patients from a distance.

Michael Coughlin

"There is a larger vision, called telemedicine or telehealth, that ties technology to the delivery of health services," said pharmacist Christopher Keeys, president of MedNovations in Laurel, Md. "There is a huge need out there and just not enough providers," he continued. "Telehealth is a global trend. It lets us close gaps in care. Used appropriately, telehealth and telepharmacy can enhance access to care."

The concept is simple, said Michael Coughlin, president of ScriptPro, a telepharmacy provider in Kansas City. A pharmacist at one location receives a prescription written in another location, reviews the script and the appropriate patient data, and approves dispensing.

A technician or a dispensing machine at the other end prepares the drug, which is visually checked by the pharmacist and released to the patient. If appropriate, the pharmacist counsels the patient or discusses the script with a provider at the remote site.

"Well-structured telepharmacy allows interactions among pharmacist, patient, and other healthcare professionals similar to those you would get in person," said Susan Winckler, VP for policy and communications for the American Pharmacists Association. "Telepharmacy allows more patients to access pharmacy and pharmacy services."

The only difference between traditional practice and telepharmacy is that the pharmacist and patient are far apart—sometimes thousands of miles apart. Texas may hold the distance record: A telepharmacist currently living in Italy is reviewing drug orders in Texas.

"I see an almost explosive interest in telepharmacy," Coughlin said. ScriptPro has provided remote dispensing systems for the U.S. military and other government agencies. "A couple of years ago, telepharmacy was intriguing. Now we see an outpouring of ideas."

The idea of using technology to extend health services is hardly new. As technology improves, so does telehealth. In the early 20th century, physicians in Australia used the highest technology of the time, radio, to provide advice and consultation to remote ranches and communities. By the early 1990s, radiologists were using digital imaging to read X-rays taken down the block or halfway around the world.

Today, hospitals across Massachusetts use video and computer links to give hospital emergency rooms immediate access to stroke neurologists, noted Joseph Kvedar, M.D., past president of the American Telemedicine Association and president of Partners TeleMedicine in Boston. The company helps physicians and patients worldwide connect electronically with Harvard Medical School specialists. State law requires ERs to provide stroke neurology services, he explained. There are not enough specialists for 24-hour coverage at every ER, so telemedicine fills the gap.

A survey by Spyglass Consulting Group in Menlo Park, Calif., earlier this year found that 65% of healthcare organizations have a strong interest in a piece of telemedicine called remote patient monitoring. Successful programs include virtual intensive care units, where a central intensivist monitors ICU patients across multiple hospitals, and remotely monitors patients with congestive heart failure, pediatric asthma, diabetes, obesity, and a variety of other conditions.

"Caregivers at the other end are the arms and legs for the knowledge person," Kvedar said. "The judgment piece of care doesn't necessarily require a personal presence."

Remote hospitals

In Spokane, Wash., Sacred Heart Medical Center pharmacy director Larry Bettesworth, Pharm.D., came to a similar conclusion. His 623-bed institution had enough pharmacists to provide 24-hour order entry and drug utilization review, but smaller institutions in the state needed help to cover night and weekend shifts. Some hospitals relied on a community pharmacist. Others had no R.Ph. services at all.

Bettesworth convinced Sacred Heart and the state pharmacy board to pilot a program using Internet technology to link his pharmacists with a remote hospital. The part-time experiment has grown into a self-supporting program with nine remote hospitals and seven full-time equivalent R.Ph.s who review 15,000 to 16,000 drug orders every month.

The remote hospitals pay for pharmacy services based on drug order volume. Most are designated as critical access institutions, Bettesworth said, which entitles them to additional payments from the Centers for Medicare & Medicaid Services. The additional federal funding helps cover telepharmacy and other services. "It is more economical to contract with us than to hire multiple pharmacists for after-hours service," he said. "Telepharmacy has been very effective in encouraging and assisting these smaller hospitals. There is a real push to ensure patient safety, and hospitals are looking for these kinds of alternatives."

Some of Bettesworth's telepharmacists work in a typical hospital setting and some work out of their homes. Either way, he said, Sacred Heart helps the remote hospital design a complete medication management system that includes 24-hour order entry review, drug utilization review, and automated dispensing.

Pharmacists in Spokane or in neighboring Montana use computer links to review and approve drug orders before dispensing. Real-time video links also allow telepharmacists to supervise tasks such as refilling dispensing devices or talking with pharmacy technicians, nurses, physicians, and patients.

"If the hospital can recruit pharmacists to work on site, that is obviously better than remote services," Bettesworth said. "But it is impossible to recruit and keep pharmacists in some of these communities. That's where telepharmacy comes in."

Into the community

Telepharmacy, like other forms of telehealth, offers three distinct benefits, according to Kvedar. Programs can provide improved quality of care, improved access to care, or improved efficiency of care.

Programs are most effective in physical locations or types of care that have a shortage of providers. That makes pharmacy a prime candidate. "We see a lot of interest in telepharmacy as a way to improve access to pharmacists," said Douglas Scheckelhoff, director of pharmacy practice sections for ASHP. "The data are pretty compelling that these arrangements can be effective." About 12.2% of hospitals nationwide are using telepharmacy, according to ASHP data. Among smaller hospitals, that percentage rises to 17%.

Large institutions also use remote pharmacists. Most use telepharmacy to cover night and weekend shifts. Some use it to speed order review during peak hours.

One of the fastest growing models is shared pharmacist services, Scheckelhoff said. A group of small hospitals that can't afford 24-hour pharmacy services join forces to create a central approval and review center with 24-hour service.

There are similar moves on the community side. Thrifty White Pharmacy, a regional chain concentrated in Minnesota and North Dakota, is reportedly considering a central telepharmacist who would oversee multiple satellite pharmacies staffed by technicians.

Independent R.Ph.s are already using telepharmacy to cover for one another during lunch, breaks, weekends, and vacations. "These pharmacists can actually have a life now, thanks to telepharmacy," said Ann Rathke, telepharmacy coordinator at the North Dakota State University College of Pharmacy. "That's a positive change from what has generally been a downward trend in pharmacies here."

Eight to 10 states have recently revised regulations or are in the process of revising them to ease the way for telepharmacy. Many states already mention telepharmacy in their regulations, said Carmen Catizone, executive director of the National Association of Boards of Pharmacy, though not all have active programs. "We are supportive of progressive changes," he said. "But we also want to be sure the safety and security aspects are there. We are working with telepharmacy, not trying to slow things down."

Most state boards want to prevent telepharmacy competition with existing pharmacies. Texas, for example, requires telepharmacies to be at least 10 miles from the nearest brick-and-mortar pharmacy.

"We are aware that you don't want to drive pharmacists out," said Marilyn Kelly-Clark, program manager for the Montana state pharmacy board. "There aren't enough of them as it is."

The Montana Pharmacy Association is trying a different tack. At its recent annual meeting, the group solidly supported policy calling for telepharmacy as part of a larger solution to meet the medication needs of the community.

In addition to prescription drug access, said Minnesota Pharmacists Association president Todd Sorensen, pharmacy providers and the state pharmacy board should ensure access to nonprescription medications, consultation, medication therapy management, and collaboration with other community providers and leaders. "Telepharmacy always comes up as a potential solution in communities at risk of losing their local pharmacy," he said. "A pharmacist is more than a point for dispensing drugs and healthcare information. There is more to medication therapy and management than just filling scripts."

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Electronic data aid patients, physicians

Posted on Mon, Jul. 31, 2006

A potentially major development in modern health care for many Hoosiers occurred May 1 when state Medicaid coverage expanded to include reimbursement for telemedicine costs.

Telemedicine involves the electronic transmission of medical data from patients at remote sites to physicians and other health care providers, eliminating the need for travel and reducing the costs for many consultations and examinations. In the United States, home health care visits by nurses number about 500 million annually. And for many of the nearly 2 million Hoosiers who live in rural areas, the need for telemedicine can be quite compelling.

Telemedicine can be found in an ever-growing set of new technologies. Videoconferencing is the most obvious because it allows the patient and the health care provider to confer directly and in real time via the Internet.

However, other forms of remote technologies now include otoscopes that collect medical data through the ear canal, digital thermometers that scan the temporal artery on the forehead and non-invasive finger sensors to measure the heart rate and oxygen saturation level in the patient’s blood.

Additional digital equipment is used to monitor a patient’s weight, blood pressure, glucose level, blood clotting time, and breathing capabilities. Remote examination cameras, electronic stethoscopes and videophones designed for independent operation by a patient at a remote site. Data then can be transmitted to a physician for immediate analysis, or they can be stored in video, audio and text files for later evaluation.

In telesurgery, an operation is transmitted via videoconferencing to other sites for consultation with other surgeons and for educational purposes. In telepharmacy, a prescription may be transmitted by a pharmacist to a remote location where it is filled by a pharmacy technician.

Because extensive amounts of public health data about large numbers of patients can be collected and correlated via such technologies, telemedicine also provides opportunities for new avenues of research as patterns of patient behavior and treatment are investigated using these data. Moreover, the educational potential of telemedicine is enormous as it can link health care professionals, patients and students separated by large distances.

Although reimbursement by Medicaid to those eligible for such assistance is a major step forward for Hoosiers, there are other obstacles that must be overcome if telemedicine is to fulfill its promise. One technical obstacle is bandwidth capacity, for without sufficient bandwidth it becomes impossible to transmit large amounts of data efficiently. Fortunately, bandwidth capabilities are expanding rapidly across the state while the costs for such services are being steadily reduced.

Other unresolved issues include malpractice liability coverage for health care providers in telemedicine, licensing these professionals and ensuring confidentiality of electronic records.

Finally, the most difficult obstacle may be the reluctance of many physicians, nurses and especially patients to embrace this new technology because it differs from traditional health care.

Telemedicine may never be as satisfying as a personal visit to the doctor’s office or a home visit by a nurse, but it does provide part of the answer to how a limited number of future health care professionals will be able to attend properly to the needs of our ever growing elderly population.

And as the technology that supports telemedicine further develops and obstacles are overcome, the entire world of medical care will become much more accessible to everyone, including those living in remote locations.

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Gerard Voland is the dean of the School of Engineering, Technology and Computer Science at Indiana University-Purdue University Fort Wayne. Send questions and comments to him at volandg@ipfw.edu or 481-6839.

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Emerging technologies make best possible medical care more accessible

By Sen. Patty Murray (D-Wash.)

In my home state of Washington, we know that technology can revolutionize businesses and communities. We’ve seen it with Microsoft, with biofuels and at our research universities.

And those of us whose communities it has touched know that it is far past time that we use that same innovation to transform our nation’s healthcare system.

By expanding health information technology everywhere from bustling urban centers to rural America, we will see fewer medical errors, increased efficiency and healthier patients.

Health IT makes the best possible medical care much more accessible.

For example, a family in Alaska has a child suffering from a rare heart disorder. Normally, the child and family would have to travel to Seattle to receive care from specialists at Seattle’s Children’s Hospital. Through telehealth, the family could stay in Alaska and connect with the doctors electronically.

That’s why Congress needs to move forward with bipartisan legislation to integrate IT into our nation’s healthcare system.

One way to do this is by passing the Wired for Healthcare Quality Act (S.1418). This legislation, which has passed the Senate, will help move America’s healthcare system to an electronic records system. It would create national standards to ensure that patient records are available wherever they access care. These standards would also keep medical records private and secure.

Electronic records will help reduce medical errors, improve quality, reduce waste and duplication of services and allow for the collection of data to standardize treatment.

As the interaction between the Department of Defense and the Department of Veterans Affairs has illustrated, we need a federal standard to ensure that our health IT systems are interoperable. When soldiers come home and transition from Defense to the VA, the move should be seamless so that doctors can access a veteran’s health history and provide quality care with fewer delays, interruptions or mistakes.

The bill will also promote performance-based healthcare that rewards caregivers who offer efficient, quality service.

For example, Washington’s Medicare reimbursement rates are among the lowest in the nation. Instead of rewarding providers for keeping patients healthy or solving problems with fewer trips to the doctor, Medicare rewards the provision of services.

Hospitals and doctors in Washington and other states have suffered the economic consequences of this perverse structure. Low reimbursements have led some doctors no longer to see new Medicare patients, and still other doctors have left the state altogether.

We should be rewarding efficiency in our healthcare system, not punishing doctors and hospitals for getting the job done.

Part of the problem stems from Medicare’s complex funding system, which has historically penalized rural areas. Healthcare providers in rural states get less money from Medicare for the very same procedure performed in urban areas.

The Wired for Healthcare Quality Act would not only allow patients whose doctors have been forced to close shop to access quality healthcare remotely, but it actually rewards efficiency and quality in healthcare. And, in drafting the bill, we worked to ensure that rural providers receive the technical and financial support to invest in health IT systems.

At Inland Northwest Health Systems in Spokane, Wash., telepharmacy technology is being implemented to connect rural, remote sites with a hospital-based pharmacy and pharmacists to improve access and reduce errors.

Inland Northwest is also working to enact an electronic health-records database for most healthcare providers in eastern Washington. This would give providers real-time access to a patient’s complete health record, saving lives and promoting efficient care.

There is great potential for this technology. It could help coordinate care and disease management. It could help us develop best practices to improve clinical guidelines for treating patients.

This program also has the potential for translating research from the lab to the patient’s bedside much faster. Having real-time access to health information would also serve as an important tool in educating and empowering patients to be more involved in their own care. Many patients have little understanding of their own healthcare or even the choices their providers make relating to their healthcare.

The Wired for Healthcare Quality Act also ensures that patients have access to their own medical records. Better access will help patients become more informed consumers and more empowered to make decisions about their own healthcare.

Telehealth also provides doctors with specialized training without having to leave their communities. With innovative health IT, doctors can be trained in their own communities, making it easier for doctors and keeping professionals where they’re needed most.

Telehealth makes the best possible medical care much more accessible. Far too often in recent years, politics has trumped research, science and innovation. With this bill, we have a chance to move science and innovation forward. For our patients, their families and the future of our nation’s health, it is time to implement and fund health IT legislation.

Murray is a member of the health, appropriations and budget panels.

Source

Ascribe announces successful implementation of Hospital Pharmacy web-based IT solution

Ascribe (AIM:ASP), the health IT Group, is pleased to announce that it has successfully implemented a new web-based IT solution at Tameside General Hospital’s Pharmacy Department to manage their dispensary and stores processes. This breakthrough will enable healthcare personnel to raise requests for prescriptions to the hospital pharmacy through authorised web-access points; the main benefits are considerable time-savings and further reductions in errors. This solution also marks a major step towards further integration with other clinical systems within Hospitals such as ‘Electronic Prescribing and Medicine Administration’ (ePMA).

Speaking on behalf of Ascribe, Stephen Critchlow, CEO & Chairman stated: “We are delighted with the initial progress reports, this is a major technological breakthrough and we are now starting to make real progress in the web-based integration of clinical systems in healthcare”.

Ascribe solutions are already installed in over 60% of UK Hospitals. The new web-based architecture allows Hospitals to move forward with their prescription technology. This solution is based upon Microsoft’s SQL server, this provides a more modern and robust basis for further development.

Speaking on behalf of Tameside General Hospital, Mr Tony Sivner, Chief Pharmacist said: “The solution is up and running and it is allowing us to process our incoming prescription requests without delays. Now that this system is in place we look forward to developing further integration with our other IT systems.”

Notes to Editors.

Contacts:

Simon Mehlman, Group Marketing Manager
Tel: +44(0) 161 280 8080
Email: simon.mehlman@ascribe.com

Ben Granger, Tameside General Hospital
Tel: +44 (0) 161 922 4080

About Tameside General Hospital:
Tameside General Hospital is run by Tameside and Glossop Acute Services NHS Trust and is located in Ashton-Under-Lyne.

Situated at the foot of the Pennines, eight miles to the east of Manchester, the Trust services a population of over 250,000. The population is concentrated in the largely industrialised areas of the eight townships of Tameside, which comprises Tameside Metropolitan Borough Council. In addition to this, Glossop, with its population of approximately 28,000 is part of Derbyshire High Peak Borough Council, and provides the challenges of a more rural community.
The Trust received the full three star rating out of three from the Healthcare Commission in 2005, confirming its high quality of care. It is currently applying for Foundation Trust status.
About Ascribe plc:
Ascribe plc is a leading healthcare company that develops and markets software solutions supporting patient, clinical and business processes to the international healthcare market. The Group provides solutions to Emergency and Minor Injuries units, Mental Health and Social Care units, Hospitals requiring patient administration systems (PAS) and medical equipment management, Hospital and Retail Pharmacies, and General Practice surgeries.

Ascribe is committed to providing technologies that improve patient safety standards. Electronic Prescribing is a widely recognised contributor to the improvement of patient safety and the reduction of medication errors. A US report by the Institute of Medicine released in July 2006 reported that at least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications, this same report cited Electronic Prescribing as part of the solution. An article written by Rose Shepherd in the Sunday Times in July 2005 reported that medicines taken in the UK were responsible for killing up to 20,000 people a year in the UK — six times as many as die on Britain's roads.

Ascribe plc was floated on AIM in 2004, and currently employs 200 personnel through its seven operating companies in the UK, Hong Kong, Kenya, Australia and New Zealand. For more information, please visit www.ascribe.com.


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Duluth Medical Convo To Discuss 'Telemedicine'

Jul 17, 2006 9:07 pm US/Central

(AP) Duluth, Minn. How to connect doctors and patients through a TV, a camera and an Internet connection will be the talk of the 2006 Minnesota Health Care Conference at the Duluth Entertainment Convention Center.

More than 180 attendees from as far as southwestern Minnesota are set to learn of the process, called telemedicine, which allows doctors and patients to communicate with each other from hundreds of miles away.

Similar technologies have expanded to other health professionals, including physicians, radiologists and even pharmacists, said Sally Buck, co-coordinator of the conference.

For instance, telepharmacy allows pharmacists to fill prescriptions for people across the state, Buck said.

Attendees will get tips on how to use such technologies, said Karen Welle, who's also co-coordinating the conference.

"The conference will show some of the innovative models and success stories that hospitals have had," Buck said.

(© 2006 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)

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Long-distance medical care

Telemedicine offers specialized help for rural areas

BY BRANDON STAHL

NEWS TRIBUNE STAFF WRITER

Clint Austin/News Tribune

UMD Medical School administrative specialist Tracy Kemp talks with Dr. Gary Davis via video conference during a demonstration of the equipment used during rural medical consultations at the UMD Medical School.

When Scenic River Health Services in the small town of Cook needs a mental health consultation for one of its patients, it often looks about 90 miles away to Dr. Gary Davis, a psychologist at the University of Minnesota Medical School at Duluth.

But Davis, head of the medical school's department of behavioral sciences, never has to drive. Instead, he talks to patients through a television, a camera and an Internet connection.

Expanding telemedicine -- systems that allow doctors and patients to communicate with each other from hundreds of miles away -- as well as other medical technologies throughout the state will be the main issues during the 2006 Minnesota Health Care Conference, running Monday and Tuesday at the Duluth Entertainment Convention Center.

More than 180 registrants, along with 37 exhibitors coming from as far as southwestern Minnesota, are scheduled to attend the conference.

Telemedicine is more than just giving mental health care consultations, according to Sally Buck, assistant director of the Rural Health Resource Center in Duluth and co-coordinator of the conference.

Buck said technologies have expanded to other health professionals, including physicians, radiologists and even pharmacists.

Telepharmacy allows pharmacists to fill prescriptions for people in even the most remote areas, Buck said.

"The conference will show some of the innovative models and success stories that hospitals have had," Buck said.

Attendees will get tips on how to implement other technologies at their centers, which is a primary concern in rural areas, said Karen Welle, assistant director with the Minnesota Department of Health who is co-coordinating the conference.

Increased and improved technology, Welle said, is an answer to a shrinking work force, another issue facing rural health-care providers.

"The goal is to focus on successful community models," she said.

Welle said the conference is typically held either in St. Cloud or Duluth. She said it's not certain when it will be back again, but said the city is a popular choice because of its entertainment and restaurant options.

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BRANDON STAHL covers health care. He can be reached weekdays at (218) 720-4154 or by e-mail at bstahl@duluthnews.com.

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A second home in Ozarks for UAMS

Chancellor and others want to send students to booming Northwest Arkansas.

Leslie Newell Peacock
Updated: 7/13/2006

If all goes as planned, in the next four years, the University of Arkansas for Medical Sciences will reach an enrollment of 700 — 100 more than it has today — and 60 of its students will be located at a new satellite of the College of Medicine in Northwest Arkansas.

UAMS plans to send 30 students from each third and fourth year class to work in clinical settings in Fayetteville, Rogers, Springdale and Bentonville. Pharmacy students, students in allied health care (technicians, etc.) and nursing students will also be completing their degrees in Northwest Arkansas.

The expansion into Northwest Arkansas, a plan Chancellor I. Dodd Wilson has been discussing with UAMS staff and a few lawmakers for the past year, will require cooperative agreements with hospitals to establish residency programs. It will take advantage of already-established residency programs at AHEC (Area Health Education Center) clinic and the VA hospital in Fayetteville as well. As of now, Wilson said, no facility is planned for the med students, but the Fayetteville medical community expects UAMS will build or rent a facility as the core for the school’s students and administrative needs. The idea, Wilson said, is to send students to a place where there are ample patients and clinical sites already established — and Arkansas’s rapidly growing Northwest fills the prescription. The expansion will require cooperation with the hospitals and community; Wilson was in Fayetteville Tuesday talking to persons from the medical and lay communities to gauge support. A Northwest campus “would be a real shot in the arm for businesses to have a branch of the medical school here,” AHEC medical director Dr. Robert Gullett said.

It doesn’t hurt, it might be pointed out, that some of the state’s most well-heeled philanthropists — like Pat Walker, who has been a big donor to UAMS in Little Rock — are based there.

What will it cost to expand? The plan is so rough it has not even gone to the Board of Trustees, Wilson said, and he declined to estimate a cost. The University of Kansas Medical School-Wichita, a satellite of the main campus in Kansas City, which the chancellor and others visited recently, has 122 faculty members, 14 residencies and a budget of $25 million. Excluding start-up construction costs, UAMS, with 60 students and fewer specialties, might be less. The current budget for the College of Medicine is $404,969,110.

Whatever the cost, Chancellor Wilson said in an interview last week, “If the legislature is unwilling to help, it won’t work.”

UAMS is fortunate in that the chair of the legislature’s Joint Budget Committee is Sen. Dave Bisbee of Rogers. Bisbee said last week the only downside to UAMS expanding into his neck of the woods is that “it costs money.” But, he asked, “Do we want to educate more doctors to serve the population?” If the answer is yes, the state’s going to have to help out. Add this tab to the list of reasons why a tax cut, though politically popular, might not be so easy or desirable to do, despite the state’s big surplus.



Northwest Arkansas is said to be the sixth-fastest-growing region in the country; its population increased by half in the 1990s. Northwest Health System CEO Gary Looper said growth requires the system’s hospitals in Bentonville, Springdale, and Johnson to add 30 to 40 new and replacement doctors a year.

Not only are there more people to take care of in Northwest Arkansas, there is the fact of Arkansas’s aging population, who need more medical attention. The baby boom is turning into the patient boom. Arkansas’s population aged 65 and older is expected to increase by 68 percent between now and 2020, the U.S. Department of Health and Human Services estimates.

The American Association of Medical Colleges recommends an increase in medical school enrollment of 30 percent by 2012 to meet future demands. About 25,000 new doctors are being turned out a year at present; UAMS graduated 132 last spring. An impossible 1.2 million new nurses will be needed by 2014, the U.S. Bureau of Labor Statistics reports. There’s a shortage in the pharmaceutical profession, requiring some rural hospitals to close their pharmacies.

The College of Pharmacy at UAMS is increasing its enrollment to meet demand; all of its 90 graduates this spring were hired, more than half in Central Arkansas alone. Yearly salaries now average $93,550.

“A UAMS Report: Meeting Arkansas’s Health Care Work Force Needs” includes Health and Human Services data that ranked Arkansas 48th in physicians per capita, with 154 doctors for every 100,000 people. Nationally, the average is 198.

A survey conducted by UAMS of health care facilities in state predicted 700 doctor vacancies statewide by next year, 300 of them in primary care. It also predicted 3,000 vacancies in nursing. It quotes a state legislative panel finding that the state will need 27,000 new nurses by 2010, “roughly the size of Bentonville.”

The AAMC’s June 2006 Statement on the Physician Workforce called for increases especially in “areas where the population is projected to grow rapidly in future years.”



Sending UAMS students of medicine, pharmacy, nursing and health-related professions to the northwest corner of the state will help address the need to increase Arkansas’s doctor numbers and “alleviate stress on local facilities,” Chancellor I. Dodd Wilson, architect of the plan, said. UAMS’ lecture halls are not big enough to accommodate a class size of 180, “which is where we’d like to go,” he said.

Besides the AHEC clinic and the VA hospital, UAMS could teach its students at the Reynolds Center on Aging satellite in Springdale and the Northwest Arkansas Center for Children in Lowell. UAMS will also seek agreements with private hospitals in the region to create residency programs in internal medicine, pediatrics and surgery. Hospitals in Northwest Arkansas have been going up like Hog calls: Washington Regional in Fayetteville and Northwest Health System Hospital in Bentonville are new facilities; St. Mary’s Hospital will open a new hospital in 2007 in Rogers. Northwest’s hospital in Springdale has expanded recently, and the system also operates the Willow Creek Women’s Hospital, built less than five years ago in Johnson. Siloam Springs also has an acute care hospital.

UAMS’ medical school classrooms may be cramped by the addition of 10 new students this year and in following years, but UAMS is adding new facilities all the time. It has broken ground on a $255 million project to add 500,000 square feet to the hospital, build a psychiatric facility and student residences (which are nearly complete). The hospital is raising $25 million to $30 million in gifts to help build a $70 million cancer research center, the remainder of the cost to be paid by a bond issue (which will cost the state more than $120 million in principal and interest by the time it is repaid).

The Pat Walker Tower, a five-story addition to the Jones Eye Institute made possible by a $15 million gift by Walker, who lives in Springdale, was dedicated this spring.



Northwest CEO Looper said response to UAMS’ plans has been positive “in general.” (He qualified that by saying that at some point — though not in the foreseeable future — local doctors may come to regard the UAMS physicians as competitors for patients.) “A Northwest Arkansas campus gives us access to clinical expertise that would not normally be available,” he said, and would help the area recruit new doctors.

His counterpart at Washington Regional Hospital, CEO and president Bill Bradley, in an e-mail to the Times, said the hospital was “assisting UAMS in determining the feasibility of expanding its presence in Northwest Arkansas. At this point, there are many more questions than answers. In addition to Washington Regional’s participation, community-based physicians will need to understand and agree to their role in the programs. UAMS needs to more specifically define everyone’s role in the near future. Certainly, we will continue to work with UAMS toward a successful outcome.” He said that developing new residencies in his region would require “significant preparation.” Bradley added that it would be “more cost effective” for UAMS to use existing hospital facilities than build a new one.

But Looper said he expected UAMS would need a real campus — a “hub, a central core” — that would include laboratories, classrooms and administrative space. He expects to see philanthropic help to provide capital for such a center; a “high level of interest” among the area’s wealthy has been implied, he said.

State Rep. Jay Bradford, chair of the House Health, Labor and Welfare Committee, is in favor of the expansion, in light of the growth and support of the medical community and “the chamber of commerce types.”

“There’s also a lot of foundation money up there,” Bradford said. “I look at the UAMS campus here and see a lot of support [from Northwest philanthropists]. … I expect [they’ll] continue to support right in their back yard.”



The College of Pharmacy, which got an appropriation in the last legislative session to expand, has begun hiring faculty in Northwest Arkansas to accommodate its enrollment increase. In 2004, class size was 90; in the fall, 120 will be in the entering class. Like the College of Medicine, the College of Pharmacy will send 30 third-years and 30 fourth-years to Northwest Arkansas sites, Dean Stephanie Gardner said.

The college has already hired one person, at St. Mary’s in Rogers, to oversee clerkships; UAMS will pay half the new hire’s salary and St. Mary’s the other half. Gardner hopes the College and Wal-Mart will jointly fund a position at corporate headquarters. “We hope to have seven or eight faculty” hired over the next two years, Gardner said.

What’s the precise shortage of pharmacists? “There’s no way for us to know. What I can tell you is there are hospitals and pharmacies that call that are willing to support a student’s entire tuition if [he or she will] sign a contract to move there,” Gardner said.

Class work is still required of third year pharmacy students, so the pharmacy college satellite will need a location that includes classrooms, faculty offices and office space, Gardner said. “We haven’t identified that place,” she said.



The College of Medicine gives priority to Arkansas resident applicants, and until this year accepted 150 students a year. Famously, in 1988, only 222 Arkansans applied for the 150 spots available. Arkansas applicant numbers have grown (as have out-of-state applicants): In 2005-06 there were 694 applicants, 262 of whom were Arkansans, and in 2006-07, there were 949 applicants, 292 of whom were Arkansans. The entering class this fall will have 160 students for the first time.

If the school is to grow to 180 students, in Dean of Academic Affairs Richard Wheeler’s opinion, more out-of-state students must be accepted.

The College of Medicine is required to take an equal number of applicants from the four congressional districts to make up 70 percent of its entering class. This year, that means each of the districts were promised 28 slots. Of the remaining 30 percent, only half may be accepted from out of state.

Given those circumstances, the limit on out-of-state applicant numbers might make it hard for UAMS to fill a class of 180 with top-notch students. “I don’t know that that would be enough,” Wheeler said. “We may very well need to go to the legislature to say we need to relax that.” The quota system may have to go, too, Rep. Bradford said.

Wheeler said the reason for the limits on non-Arkansans — that those who pay state taxes should reap the benefits — doesn’t take into account that doctors tend to stay in the cities they did their residencies in, even if they’re not from the area.



Chancellor Wilson and UAMS are going to have to make the case to expand the school, Sen. Bisbee said. “You won’t get anything through the legislature unless rural Arkansans think they’re going to get their medical needs taken care of.”

For years, Fayetteville and Little Rock have argued the need for two law schools. Can a comparison be drawn? Said Wilson: “Law schools don’t do residencies, they don’t need customers. Med school students need patients.” They’ll find them in his hometown, Rogers, and the rest of Northwest Arkansas.


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Wanted: pharmacists to fill critical need in U.S.

UA expanding College of Pharmacy into Phoenix

LA MONICA EVERETT-HAYNES
Tucson Citizen Published: 07.07.2006

More people are relying on prescription medication to treat illnesses, but the pharmacists trained to hand out those sometimes lifesaving drugs come in short supply.

Add to that Arizona's booming population, and you've got the makings of a shortage that is spurring some pharmacies to offer signing bonuses and nearly six-figure salaries.

About 45 percent of the nation's population has been prescribed at least one drug compared with 35 percent in 1994 - making the United States the most medicated of all nations, several health experts say.

Pharmacy school is hard, but the problem is not a lack of applicants.

"One of the problems with the pharmacist shortage is that colleges cannot turn out pharmacists fast enough to meet the demand," said Don Featherstone, who hires pharmacists for Bashas' supermarkets in southern Arizona. "It's an ongoing search. There is rarely a time when you're not looking for somebody."

Qualified pharmacists can save lives, catching potentially fatal prescription errors and making sure patients know how to take their medication. Hundreds of people die each year because of prescription errors, researchers say. Thousands more die because of adverse drug reactions.

Given such problems - and hoping to help build the state's biomedical hub - University of Arizona officials plan to expand the College of Pharmacy into Phoenix as early as this fall.

"There is a critical shortage of pharmacists across the country," said Judy Bernas, UA's associate vice president for advancement. "We will start small, then possibly grow to the size of the Tucson programs."

Changes in practice

The Phoenix program won't just aid in the pharmacists shortage. It could help revolutionize the practice.

UA officials plan to introduce a new field of study to Arizona - a rare clinical pharmacogenomics program to teach would-be pharmacists to tailor drugs to each patient's genetics.

This could reduce chances of patients having allergic reactions and side effects, "even to prevent a liver problem," said J. Lyle Bootman, UA's pharmacy dean.

"It's happening in clinical settings, but is very, very limited," Bootman said. "Much more research must be done."

Such a practice could especially benefit minority groups, older people and patients with diseases such as cancer and diabetes.

The method builds on the centuries-old practice of compounding custom-made medicine. These days, most pharmacists have little occasion to use such custom mixes, but the knowledge involved is critical, experts say.

"Medicine is about to go through some significant changes, and we need people out there so when you're handed a drug, it's not just everybody's. It's going to work for you," said David Burks, senior director of development for UA's pharmacy college.

Pharmacists would be among those at the helm of this change.

Adding to the history pharmacists already keep on their patients, they would maintain a database of genetic information for each person.

Wanted: skilled pharmacists

But the immediate problem is managing the workload and the time it takes to fill a prescription.

Because of the competition for more pharmacists, those who are qualified in Arizona can expect salaries approaching the six-figure range, with bonuses between $20,000 and $30,000, said Featherstone, a practicing pharmacist whose company is opening about 10 new Arizona pharmacies each year.

Just two years ago, bonuses averaged about $15,000, he said.

"The sign-on bonus is actually new to pharmacy. In the last seven or eight years, it's become very common to offer them," he said.

More than 5,300 licensed pharmacists live in Arizona, but about 15 percent don't practice, the Arizona State Board of Pharmacy reported.

The number of pharmacies has doubled. The board reported there were more than 1,500 registered chain, independent, hospital and other pharmacies last year, up from 765 in 1995.

Some pharmacists work multiple jobs in the field and others work more than 40 hours a week, which can result in errors. Meanwhile, patients must sometimes wait days before a prescription is filled.

The demand is so severe that pharmacist and UA College of Pharmacy graduate Amy Thai is already considering expanding her six-month-old practice to offer Internet and mail-order sales.

"By 2008, the baby boomers will reach retirement age and that's going to have a great impact on the pharmacy," said Thai, 28, owner of Arizona Discount Pharmacy in Mesa.

Nationwide statistics say the same.

Since 1995, the nation has seen a 54 percent increase in the number of prescriptions handed out - now more than 3.2 billion annually, the National Association of Chain Drug Stores reported.

About 18 percent of the population is prescribed three or more drugs, compared with 12 percent in 1994, the U.S. Department of Health and Human Services noted in a 2005 report on the nation's health.

Increasingly common outpatient surgery, swift development of new drugs and the push to reduce deaths from adverse drug reactions are also driving the need for more pharmacists.

Yet too few training slots exist for the number of students interested in studying pharmacy, said John Murphy, associate dean of UA's College of Pharmacy.

UA's pharmacy college in Tucson is filled to capacity and graduates nearly 150 students each year.

That's why the Phoenix program - which should produce more and better-trained pharmacists - is so hopeful, David Burks said.

"If you have more doctors and more pharmacists," Burks said, "you'll have a health care system that can deliver more equitably and faster to more people, sooner."

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Licensed druggists become hot commodity

by Greg Erbstoesser, Journal Staff



: SYRACUSE — Mirroring national trends, pharmacists are in hot demand across upstate New York as the population ages, prescription-drug usage rises, and drug stores expand.

Beginning salaries on average of $95,000, company-stock-purchase options, extensive health-insurance packages, tuition reimbursement, discounts on purchases, and even special home-loan programs are just some of the perks drug stores are using to entice pharmacists to join.

Christine Verrillo, a pharmacist at Lyncourt Drug of Syracuse and an officer with the Onondaga County Pharmacists Society, says she and other pharmacists are constantly being solicited for job openings. Lyncourt Drug is owned and operated by Henderson’s Drug Store, Inc., a six-store, independent chain based in Penn Yan.

Job opportunities abound for pharmacists, adds David Setta, a Binghamton pharmacist who represents the Pharmacists Society of New Southern Tier chapter.

“It’s virtually impossible — you have to try really hard to be unemployed,” continues Setta, an Eckerd pharmacist on Robinson Street on Binghamton’s East Side.

“There’s a shortage of pharmacists everywhere, and the Southern Tier is no different,” he added.

“From all the predictions I’ve seen, there is going to be no end to the shortage,” Setta notes.

Hiring or sign–on bonuses and referral bonuses offered by drug-store chains are not uncommon, says Santo Garro, owner of the one-store, independent, Garro Drug Store of Utica.

“Everybody does it,” he said of the chains and the use of hiring and referral bonuses, particularly when they need to fill a vacancy in small–population areas such as Lake Placid, Saranac Lake, or Plattsburgh. Garro is president of the State Pharmacist Society’s Mohawk Valley chapter.

Indeed, the findings of a report by the Pharmaceutical Care Management Association (PCMA) — a national association representing pharmacy benefit managers — suggest a robust job market likely will continue over the next 10 years for pharmacists in chain drugstores, supermarkets, independent pharmacies, hospitals, and mail-service operations.

The PCMA also cites a Money magazine and Salary.com survey in April that notes the demand for pharmacists is exploding as the population ages and new medications are developed.

By 2010, the number of prescriptions filled is expected to rise 27 percent to 4.1 billion, according to the Money/Salary.com survey.

Pay rises

Today, the average salary of Albany College of Pharmacy (ACP) of Union University graduates is about $95,000, school officials note.

“Three years ago, it was in the high 70s,” ACP communications director Ronald Lesko recalls.

ACP officials noted graduates this year had, on average, two job offers to consider.

ACP is one of the few schools in upstate New York that produces pharmacists.

According to the PCMA survey, the expected 2006 median, total-cash compensation for a staff pharmacist nationally is $98,300 compared to $93,300 in 2005, an increase of 5.4 percent.

Similar increases were also seen for other related pharmacy professions, including pharmacy-operations manager, pharmacy-team manager, clinical pharmacist, technician, and new graduates of pharmacy schools, the association noted. And that doesn’t count the other incentives drug-store chains use to entice pharmacists to join their ranks.

Drug-store chains like CVS and Walgreens have even teamed up with the American Association of Retired Persons (AARP) to promote coming to their companies.

“Whether you’re looking for a flexible part-time position in one of our over 6,000 stores, a pharmacist or management career, or you have the experience and skills as a senior executive, take a look at what CVS/Pharmacy has to offer,” CVS’s Web site states in encouraging retirees, 50 years and older, to consider returning to the work force.

Walgreens is the latest national player to move into Central New York, and the Southern Tier. Walgreens is building a store in Johnson City.

As of May 31, Walgreens operated 5,251 drugstores in 45 states and Puerto Rico, versus 4,837 a year ago, the company noted in a June 26 statement.

The Walgreens’ game plan is to grow to 7,000 stores in 2010. The company has about 1,300 approved new locations and thousands of additional targeted, potential sites throughout the United States, says Walgreens’ CEO and Chairman David Bernauer in a statement released on June 26. The drug store chain reported store sales increased 12.4 percent to a record $12.2 billion for the third quarter and 11.1 percent to $35.2 billion for the first nine months.

Store growth causes shortage

“There is a shortage [of pharmacists] nationwide,” says Mehdi Boroujerdi, dean of the Albany College of Pharmacy, “but that’s really because of the expansion of the chain drugstores.” And, while the shortage may continue for the next five to 10 years, Boroujerdi says the store expansion ultimately will slow.

The dean also notes that pharmacist shortage is in rural areas, and not in large metropolitan regions.

And that’s when the added perks, such as higher salaries, hiring bonuses, even automobiles, are used entice prospective pharmacists to join a chain.

Setta of Binghamton points out another cause for the druggist shortage is the requirement imposed several years ago that calls for pharmacy students to receive a doctor of pharmacy degree, a six-year program, rather than the previous five-year academic program requirement.

Mark Brackett, vice president for human resources at the Gouverneur–based Kinney Drugs Inc., says the Central New York chain faces the same pressures to fill its pharmacist vacancies.

Brackett says the drug-store chain has developed close ties and relationships with pharmacy schools throughout the Northeast — participating in job fairs and other school functions — in order to meet and hire new pharmacists.

Kinney also encourages its pharmacists to lecture at different pharmacy schools.

“It’s a nice opportunity,” he says, to meet with potential pharmacist candidates.

Kinney has 80 retail stores — 67 in upstate New York and 13 in Vermont — as well as three institutional pharmacies that cater to nursing homes, long-term care centers, and correctional facilities, says company spokeswoman Stephanie LaDue. Brackett also points to the company’s in-house pharmacy technician-training program as another way to “try to have the best support staff” and provide better working conditions.

Garro says, however, as an independent, one-store pharmacy, he is hard-pressed to compete against the large drug-store chains and their inducements when looking for a new pharmacist.

“They offer all kinds of benefits; it’s expected,” he says.

“I would have to offer $20,000 over what the chains offer,” Garro says, as well as come up with a similar benefit package to attract candidates to consider leaving a chain, coming to a small, independent pharmacy. That, many times, is financially impossible, he says.

Instead, Garro says: “You have to be a special person to work for a community pharmacy.”

Pharmacy schools

The New York State Education Department’s Office of the Professions, which licenses pharmacists, reported there were 19,166 licenses as of Jan. 1, 2004, for the entire state. There were 590 licenses issued in 2004, and another 717 issued in 2005, according to the agency’s latest report on its Web site.

A new pharmacy school will open its doors this fall to add more people to the pharmacy graduate pool. New York State currently has only four schools that offer pharmaceutical degrees, only two of which are in Upstate.

The four are: St. John’s University’s College of Pharmacy and Allied Health Professions in Queens; the Arnold & Marie Schwartz College of Pharmacy and Health Sciences at Long Island University, Brooklyn; the University at Buffalo’s School of Pharmacy and Pharmaceutical Sciences; and ACP, the oldest pharmacy school in New York State and one of the only private, independent pharmacy schools in the United States.

However, seeing an impending shortage of pharmacists in Central and Western New York, St. John Fisher College in Pittsford (near Rochester) will open its new Wegmans School of Pharmacy this fall — thanks to a donation from the late Robert B. Wegman, former chairman of Wegmans Food Markets, Inc.

Wegman donated $5 million in January 2005 to fund the building of the new school of pharmacy.

The 37,000-square-foot building bearing Wegman’s name is expected to open this August, with an expected first-year enrollment of 50 students this fall, school officials say. Total cost of the new building was estimated at about $7 million. The three-story school, adjacent to the college’s Skalny Science Center, will contain classrooms, laboratory space, and offices for faculty and administration. It will be connected to the science center by a two-story atrium.

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Contact Erbstoesser at greg@tgbbj.com

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Grads on rise, but pharmacies see shortage in future

By RON BARTIZEK

More people taking more drugs means more need for pharmacists. But despite increases in the number of pharmacy schools and graduates, projections show there will not be enough in coming years.

“Nationally and regionally there is a big shortage of pharmacists,” said Dr. Edward Foote, associate professor and chair of Pharmacy Practice at Wilkes University. “We’re just not making enough.”

The nation’s 37,000 chain pharmacies reported about 4,000 job openings recently. That was down from a peak of 7,700 in 2001, but the improving trend could turn around as the baby boom generation ages and more seniors sign up for the Medicare prescription drug program.

Wilkes has stepped in with its Doctor of Pharmacy program, which graduated its first class in 2000. Now averaging 65-70 graduates yearly, Foote says there’s more interest in the program than Wilkes can accommodate.

“If we wanted we could have a class of 300,” he said. And the quality of applicants is rising along with applications. He says the reasons are easy to understand.

“It’s because it’s a solid job market with good pay that can start easily in six figures.” Many employers also are paying sign-on bonuses, and the profession looks to be secure, with a consortium of pharmacy groups projecting a shortage of 157,000 pharmacists nationwide by 2020.

Nationally, the number of pharmacy schools has grown in the past two decades by 20 to 92, producing about 8,200 graduates in 2005.

One way chain pharmacies find qualified help is by enticing owners of local stores to come to work for them. “We do approach the local pharmacies,” said Walgreens spokesperson Carol Hively, to see if they might be interested in trading their independence for job security.

Some individual store owners may be ready to slow down or may not have family members who want to take over, she said. Chains then pay for customer lists and the pharmacist comes to work for them.

That continuity can help the new store get off to a good start, said Mitchell Corwin, an equity analyst for Morningstar.com, because people in small communities know and trust the pharmacist. “That’s an important relationship.”

Foote does not see competition here driving established pharmacists to the chains. “They all have thriving businesses to my knowledge,” he said. “There is a lot of loyalty to these small businesses.”

At the moment, Foote says there is no shortage of pharmacists in Northeastern Pennsylvania, but his brother, a pharmacist in Delaware, has told him about stores that have cut back hours because staff was lacking.

In addition to the job security provided by the growing demand for prescription drugs, Foote looks forward to passage of legislation that will expand pharmacists’ responsibilities.

“Hopefully they’ll expand the area where pharmacists can do more advanced practice stuff,” he said, such as immunizations, counseling and simple clinical operations such as taking and analyzing blood samples.

“It’s really a tenuous but exciting time for pharmacy.”
Ron Bartizek, Times Leader business editor, may be reached at 970-7157.


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