Telepharmacy Helps Address a Lack of Rural Pharmacists

Telepharmacy helps rural Othello (WA) Community Hospital cope with a shortage of pharmacists.

Shortly after the 25-bed critical access hospital lost its full-time pharmacist seven years ago, it began a pilot telepharmacy project with Sacred Heart Medical Center in Spokane, about 110 miles northeast of Othello.

Today, the hospital has round-the-clock pharmacy coverage for its patients, a rarity for a hospital its size. Less than 2% of small hospitals – those with less than 50 beds – provide 24-hour pharmacy service.

“Rural hospitals have a hard time keeping a pharmacist and this has been a lifesaver for us,” said Othello Community Hospital nurse Rhonda Golladay, who manages the hospital’s pharmacy program. Othello was the first of what are now eight rural Washington hospitals connected through videoconferencing and other technology to Sacred Heart’s pharmacy.

While the shortage of available pharmacists confronts hospitals across the country, it is particularly acute in rural America. The ratio of pharmacists to population is lower in rural areas, with only 66 pharmacists per 100,000 people, compared to 78 pharmacists per 100,000 nationwide, according to the American Pharmacy Association. Only 12% of pharmacists practice in rural areas.

While the shortage isn’t expected to run its course anytime soon, Golladay believes telepharmacy can ease the pain for many rural hospitals. Under the program, Othello nurses enter medication orders into the pharmacy computer, then fax a copy of the original orders to Sacred Heart for review by a pharmacist. The pharmacist reviews the dosage and drug interactions and completes the order entry in the computer. After Sacred Heart’s pharmacist approves the order, a nurse at Othello swipes an identification card and types a password into an ATM-like machine that dispenses medications. The nurse enters the patient’s name and selects the appropriate drug, which causes the machine to open the drawer containing the drug.

Telepharmacy also enables rural hospitals to refill the dispensing machines with medications, which Othello usually does about three times a week. The Washington state Board of Pharmacy approved that refill method when hospitals don’t have on-site access to pharmacists. Through the videoconferencing network, pharmacists at Sacred Heart can watch nurses at the rural hospitals refill the drawers to ensure the accuracy of a drug’s placement.

The program has led to a dramatic reduction in the hospital’s medication error rate, which today stands at 0.1%. “Before telepharmacy, we had medication errors at least twice a month … a doctor wrote a prescription, and it was misread or misinterpreted because of illegible handwriting,” Golladay said. “We have not had one of those errors in five years.”

Golladay said nurses are pleased that they can communicate with pharmacists who understand intravenous drugs and other medication issues that hospitals face. “Many small rural hospitals depend on their retail pharmacist who may come in one or two days a week,” she said. “But we need hospital pharmacists. [Telepharmacy] provides the basic foundation for hospital pharmacy services in small rural communities.”

This article 1st appeared in the April 16, 2007 issue of AHA News

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Pharmacy schools hot in Tennessee

NASHVILLE, Tenn.

Responding to a growing demand for pharmacists, Belmont University will open a pharmacy school next year. So will Lipscomb University. And Union University.

Among those three schools and East Tennessee State University, which opened its school in January, the state could go from having one pharmacy school to five in just a year and a half, which begs the question: Will the shortage of pharmacists become a glut?

The number of pharmacy schools nationwide already has increased from 84 to 101 in the past five years, said Lucinda Maine, executive vice president of the American Association of Colleges of Pharmacy, and more schools are planned -- not just in Tennessee.

But Tennessee is unique in the rapid increase of schools planned.

"Going from one school to five schools in a year or two years is really unprecedented," she said. "That's not happening any place else."

Jennifer Athay, associate director of student development at the American Pharmacists Association, said, "I know there have been some discussions within the pharmacy profession about, 'OK. When is it going to be too much?'"

The new dean of Lipscomb's College of Pharmacy in Nashville said that is a fair question, but he doesn't think Tennessee has reached that point.

"There's a huge need for health care services ... that's going to drive the need for pharmacists in the foreseeable future," Roger Davis said.

The former assistant dean for Middle Tennessee at the University of Tennessee College of Pharmacy in Memphis said the baby boomers are aging, but also living longer and will need medical care for many years to come. Also, drug innovations mean more problems can be treated with medication.

Tennessee has a shortage of about 1,060 pharmacists and 157,000 are needed nationally, according to a Belmont news release.

David S. Dockery, president of Union University in Jackson, said despite the other new programs, he thinks Union graduates will be able to find work as pharmacists.

"The shortage -- from all the statistics -- is great," he said. "At least for the next 10 years, I don't see any saturation point."

ETSU dean Larry Calhoun was even more optimistic. The Johnson City school's mission is to train pharmacists to work in rural communities where Calhoun said he thinks there will always be a need.

Belmont officials in Nashville would not comment for this story, but referred to its media release sent Tuesday announcing its new program.

In the release Jack Bovender, CEO of Nashville-based Hospital Corporation of America, made a case for the pharmacy school.

"With over 80 million baby boomers not only in growing need of health care, but retiring from the health care industry, there are huge demands for health care professionals that we have to meet somehow," he said.

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Belmont announces pharmacy school

Belmont University today announced it will open a School of Pharmacy for the 2008-2009 academic year.

The private Nashville university has been building its allied health programs in recent years through the expansion of its nursing school, involvement in a Partners in Nursing consortium with several other universities, and construction of the $22.5 million College of Health Sciences & Nursing facility.

The four-year, graduate pharmacy program is intended to help alleviate a predicted nationwide pharmacist shortage, projected at 157,000 in the U.S. and 1,060 in Tennessee, according to Belmont.

Lipscomb University, also in Nashville, received approval for its pharmacy college in November and will enroll its inaugural class in the fall of 2008 as well.

Belmont has nearly 4,500 students.

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Telepharmacy project at the GLFHC West site

The Greater Lawrence Family Health Center recently announced the grand opening of the Telepharmacy project at the GLFHC West site, 700 Essex St. in Lawrence. The program is the first-of-its-kind project in Massachusetts which allows increased access to prescription drugs via remote medication dispensers.

"The Health Center has worked closely with the Board of Pharmacy, the Massachusetts Department of Public Health, and the Massachusetts College of Pharmacy and Health Sciences to help launch the program," according to Robert Ingala, GLFHC Chief Executive Officer. "MCPHS will work with the Center in order to help evaluate patient compliance and measure project successes." One way the Telepharmacy will improve patient compliance is its ability to print labels and directions in a patient's native language.

The Automated Drug Dispensing System (ADDS) allows pharmacists to reach more patients in more locations. The self-contained, computer-controlled automated prescription dispensing system which allows for the remote monitoring and dispensing of pre-packaged, unit-of-use pharmaceuticals is HIPPA-compliant. Along with the technology, patients are required to receive prescription counseling from the GLFHC pharmacist via a two-way audio and video system in a private counseling area.

From the clinical aspect, the ADDS system allows for quicker interaction with the patient, the pharmacist and the physician in the event of problems like drug interaction or insurance issues.

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Pill machines ease prescriptions

Mechanical pharmacies made by Pleasanton company help patients in remote locations

By Lea Blevins

MEDIANEWS STAFF

PLEASANTON - Imagine living in a place with no drug store for miles around but still being able to obtain prescription drugs and consult face to face with a pharmacist.

PickPoint Corp., based in Pleasanton, is making that possible. And co-founder Richard Lee promises that it's only just begun to revolutionize the pharmacy world.

Lee is a resident of Volcano, about 60 miles east of Sacramento, but co-founders Kevin Delaney and Peter Swidzinski are from the Tri-Valley. Lee works about three days a week in the Pleasanton office.

Lee has a background in factory automation and was interested in working on packaging for drugs when the PickPoint idea began.

The products are designed to store and dispense prepackaged medications of various types that will increase pharmacy efficiency and provide access to drugs for people in remote locations.

PickPoint's main product resembles a vending machine but is filled with bottles and pill packs instead of candy bars and chips -- and it has bulletproof glass.

The security features allow the machines to be placed in distant locations, such as Alaska's Aleutian Islands, where they may be situated in a hut out in the middle of nowhere.

Doctors and other care providers use PickPoint's computer technology system to request a prescription from a pharmacist in Anchorage, who can speak to the providers via video cameras in real time. The computer program also allows for close-up measuring and viewing of pills to ensure that the prescription is correct.

"This is truly the next generation," Lee said.

In its few years of business, PickPoint has already attracted a wide customer base.

The military uses PickPoint's machines to run what is called a "telepharmacy" for its troops serving in remote locations, including ships.

The machines are installed in more than 125 U.S. Army, Air Force, Navy and public health service locations around the world.

The Alaska Native Medical Center, which uses PickPoint's technology, established the Southcentral Foundation Telepharmacy Program, based in Anchorage, with more than 36,000 patients in a 2,000-mile area.

"You can be anywhere, and we can give you pharmacy assistance and control," Lee said.

In addition to setting up machines in remote sites, PickPoint sells them to hospitals and pharmacies to keep behind the counter. The machines are the same except for the front door, which doesn't include bulletproof glass and allows pharmacy personnel to reach right in and grab the filled prescription.

The pharmacy inside Safeway near the Blackhawk community in Danville features PickPoint's machines behind the counter.

The pharmacy has the vending-machine-style model as well as a set of drawers that light up to direct pharmacists to the location of a prescription.

The machines allow pharmacy staff to save time by reallocating what work they do and when, said pharmacy manager David Flower.

Although pharmacists still have to fill individual bottles of pills and load the machine, the process is speeded up by filling multiple bottles at once instead of filling them as each prescription comes in.

"The best advantage of this thing is when we do have downtime, we're using it up," Flower said.

Lee said PickPoint is currently working on other technology to improve the pharmacy world, but it won't be ready for a few months. He said people can begin to imagine getting their prescriptions filled in seconds rather than what now is often an hour's wait.

"The technology we have coming is so dramatic," Lee said. "This is stuff that people have never seen or heard of."

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Pharmacists group honors Phil Montgomery

State Rep. Phil Montgomery, R-Ashwaubenon, has been named Pharmacy Society of Wisconsin 2007 Legislator of the year.

Montgomery has been a vocal advocate for Wisconsin pharmacy on issues such as the state budget and licensing of out-of-state pharmacists, according to the group.

He was instrumental in stopping legislation that would have placed serious restrictions on the ability of pharmacies to purchase prescription drugs from licensed wholesalers. And he is working to develop legislation that would allow for remote dispensing of prescription drugs, according to the group.

Montgomery will be honored at a reception on Wednesday at the Inn on the Park in Madison. The award is presented each year in conjunction with the annual Pharmacy Society of Wisconsin Legislative Day.

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Board approves MCH renovations

Operating rooms to undergo major overhaul

Operating rooms at Medical Center Hospital will be looking a bit different over the next two years.
The Ector County Hospital District Board of Directors voted Monday to fund $2.5 million toward the first phase of operating room renovations.
The renovation will turn two of the hospital’s 12 current operating rooms into one state-of-the-art endovascular suite, officials said.
“It’s just time,” Medical Center Chief Executive Officer William Webster said. “Our current O.R. is 30 years old.”
By the time the entire operating room area is renovated in 2009, Webster said it would bring Medical Center’s inpatient facilities up to the standards of its Wheatley Stewart Medical Pavilion, which opened in 2004.
The board also approved the purchase of 26 McKesson CarePoint-RN carts for $249,356. Lisa Corley of Medical Center’s clinical informations system said the robots pick out medication and put it in envelopes for patients.
The machine eliminates errors by reading bar codes, she said.
“That makes it almost impossible to give the wrong medication to patients,” Corley said. “That’s really the purpose, to improve patient safety.”
The board also approved a $150,000 contribution to Texas Tech Health Sciences Center’s new Women’s Health Research Institute at the Permian Basin. The amount equals a contribution made by Midland Memorial Hospital last month.
Board Member Fred Martin expressed concerns about the institute’s ability to attract women’s health care business that has gone to other hospitals.
“I cannot tell you (that) you will have a huge shift in obstetrics care,” Texas Tech Regional Dean Dr. John Jennings said. “But it’s an opportunity to do something that will put the name of both our institution and Medical Center out there in women’s health.”
In other action the board:
>> Differed discussion on emergency room/trauma call agreements until its April meeting.
>> Approved a maintenance agreement with Trane.
>> Approved an off-site nighttime pharmacist agreement with Alpine-based telepharmacy Envision-Rx for 18 months at $240,000 annually.
>> Received an update on being accredited for two years as a provider of continuing medical education.
>> Received an update on the 5 Million Lives campaign, which aims to cut 5 million incidents of medical harm at 4,000 hospitals over the next two years.

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Business fills drug orders anywhere, anytime

Pleasanton firm creates vending machines that dispense prescriptions

PLEASANTON — Imagine living in a place with no drugstore for miles and miles but still being able to obtain prescription drugs and consult face-to-face with a pharmacist.

PickPoint Corp., based in Pleasanton, is making that possible.

And co-founder Richard Lee promises that they've only just begun to revolutionize the pharmacy world.

Lee is a resident of Volcano, which is about 60 miles east of Sacramento, but his co-founders Kevin Delaney and Peter Swidzinski are from the Valley. Lee works about three days a week in the Pleasanton office.

The idea for PickPoint started in 1999 and the business opened in Danville in 2000. After outgrowing that office, PickPoint moved to Pleasanton's Hacienda Business Park three years ago.

Lee had a background in factory automation and was interested in working on packaging for drugs when the PickPoint idea began.

The products are designed to store and dispense prepackaged medications of various types that will increase pharmacy efficiency and provide access to drugs for people in remote locations.

PickPoint's main product resembles a vending machine, but is filled with bottles and pill packs instead of candy bars and chips — and it's got bulletproof glass.

The security features allow the machines to be placed in distant locations such as Alaska's Aleutian Islands where the machine may be situated in a hut out in the middle of nowhere.

Doctors and other care providers use PickPoint's computer technology system to request a prescription from a pharmacist in Anchorage, Alaska, who can speak to the providers via video cameras in real time. The computer program also allows for close-up measuring and viewing of pills to ensure the prescription is correct.

"This is truly the next generation," Lee said.

In its few years of business, PickPoint has already attracted a wide customer base.

The military uses PickPoint's machines to run what is called a "telepharmacy" for its troops serving in remote locations, including ships.

The machines are installed in more than 125 U.S. Army, Air Force, Navy and public health service locations around the world.

The Alaska Native Medical Center, which uses PickPoint's technology, received the 2006 Award for Excellence in Medication-Use Safety from the American Society of Health-System Pharmacists.

The center established the Southcentral Foundation Telepharmacy Program based in Anchorage, with more than 36,000 patients in a 2,000-mile area.

"You can be anywhere, and we can give you pharmacy assistance and control," Lee said.

Even patients in the Valley can be served by PickPoint.

In addition to the machines set up in remote sites, PickPoint sells them to hospitals and pharmacies to keep behind the counter. The machines are the same except for the front door, which doesn't include bulletproof glass and allows pharmacy personnel to reach right in and grab the filled prescription.

The pharmacy inside Safeway near the Blackhawk community in Danville features PickPoint's machines behind the counter.

The pharmacy has the vending-machine style model as well as a set of drawers that light up to direct pharmacists to the location of a prescription.

The machines allow pharmacy staff to save time by re-allocating what work they do when, said Pharmacy Manager David Flower.

While pharmacists still have to fill individual bottles of pills and load the machine, the process is sped up by doing multiple bottles at once instead of over and over as each prescription comes in.

"The best advantage of this thing is when we do have downtime, we're using it up," Flower said.

Lee said PickPoint is currently working on other technology to improve the pharmacy world, but it won't be ready for a few months. He said people can begin to imagine getting their prescriptions filled in seconds rather than what is often an hour wait.

"The technology we have coming is so dramatic," Lee said. "This is stuff that people have never seen or heard of."

To learn more about PickPoint Corp., visit http://www.pickpoint.com.

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University of Maryland School of Pharmacy Expanding to Montgomery County

The University of Maryland School of Pharmacy will take its nationally-ranked Doctor of Pharmacy program to The Universities at Shady Grove this fall. Responding to a critical pharmacist shortage in Maryland that is expected to become more severe as baby-boomers age and use more medications, the School will enroll 40 additional students at the Montgomery County campus. The School is well beyond its maximum student capacity on the UMB campus. The plan will enable an enrollment increase of one-third in the entering class.

The expansion will be supported through enrollment increase funds provided by the Governor at the request of the Board of Regents and a substantial capital investment by the University of Maryland, Baltimore to construct specialized facilities for pharmacy at Shady Grove.

UMB President David J. Ramsay says, "Such an investment is worthwhile to support the University's mission to meet Maryland's need for the vital health profession of pharmacy. Moving our PharmD program to Shady Grove also gives our research-intensive School of Pharmacy a foothold in the heart of Montgomery County's 270 research corridor."

School of Pharmacy Dean David A. Knapp says, "The Shady Grove program will eventually enroll a full four-year complement of 160 students, drawing upon the rich resources of clinical facilities and government and industrial laboratories in the region to support the doctoral program. The new location will also provide an alternative to the main campus in Baltimore for students residing in Montgomery and Prince George's counties, as well as somewhat easier access for students from Western Maryland."

The Shady Grove expansion is part of an ambitious expansion plan by the School of Pharmacy to double its PharmD enrollment over the next 10 years. Central to the effort is construction of a new pharmacy building on the Baltimore campus to house the additional faculty, students, and educational and research facilities essential to support the growth. The School received initial planning funds for the building during last spring's General Assembly and has engaged architects to begin work on the building.

It is important that the General Assembly provide continued planning and construction funds to complete the building as quickly as possible. "The new building is a critical piece of our enrollment expansion," says Knapp.

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Pharmacy school expands to Montgomery campus

University of Maryland, Baltimore, aims to meet demand with new four-year programs at Shady Grove

This fall, the pharmacy school of the University of Maryland, Baltimore, will offer its four-year degree programs at the university system’s Shady Grove campus for the first time.

The school’s expansion into Montgomery County will help meet a shortage of pharmacists in Maryland and nationwide by enrolling 40 pharmacy students each year, said university officials. The school is also planning to double the size of its classroom and laboratory facilities in Baltimore.

‘‘The move to Shady Grove is also giving the school of pharmacy a foothold in Montgomery County to establish economic development here in collaboration with the biotech community and other health care organizations,” said David A. Knapp, dean of the pharmacy school. ‘‘That can only be facilitated by moving our program down here.”

The school’s doctorate of pharmacy program requires four to six weeks rotation in a community hospital, pharmacy, company or health care agencies such as the U.S. Food and Drug Administration or the National Institutes of Health.

Rockville, Prince George’s County and Southern Maryland are among the areas in Maryland running short of pharmacists, according to a July 2006 survey of 63 drugstore chains by the National Association of Chain Drug Stores. The survey also revealed shortages in Baltimore, Arnold, Prince Frederick, the Eastern Shore and Eldersburg.

On a scale of 1 for a large shortage to 5 for large oversupply, the state of Maryland scored 1.91 on the survey, compared with its score of 2.19 in the same survey in January 2006.

Knapp said the pharmacist shortage, which began several years ago, is likely to grow bigger as the leading edge of baby boomers age and require more medications.

‘‘The need for professional pharmacists trained in the discovery, development, and use of medicine rivals the need for nurses and other health care professionals,” William E. Kirwan, chancellor of the University System of Maryland, wrote in an e-mail,

Extension of the pharmacy curriculum to the Universities at Shady Grove campus will ease a logjam of students applying in Baltimore for the 120 slots open each year, while offering a more convenient location for students in and around Montgomery County.

‘‘This came together when the Board of Regents encouraged us to deal more dramatically with the pharmacy shortage,” Knapp said. The curriculum at Shady Grove will be ‘‘a hybrid” of distance learning and live instruction.

‘‘This is a sizable expansion into this region and will expand the number of pharmacists statewide,” he said.

Maryland hospitals had a 10.5 percent vacancy rate for pharmacists in 2005, up from 8.5 percent in 2004, said Nancy Fiedler, a spokeswoman with the Maryland Hospital Association. She said 2006 figures are not yet available, ‘‘but we see no indication from the data that the vacancy rate did not continue last year.”

While the drugstore association survey showed an increase of vacancies for full-time pharmacists nationally from 3,941 in January 2006 to 4,044 in July 2006, the trend radically reversed for part-time vacancies. The survey showed only 389 vacancies for part-timers in July 2006, versus 3,558 part-time vacancies only six months earlier.

As more male pharmacists ‘‘prepare to retire and men and women opt for part-time work” the U.S. pharmacy profession ‘‘could face a worsening shortage,” according to the National Pharmacist Workforce Study in the May⁄June 2006 issue of the Journal of the American Pharmacists Association, sponsored by the nonprofit Pharmacy Manpower Project Inc.

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