Telepharmacy company covers hospitals overnight in 10 states, 12% of nation's hospitals use an off-site pharmacy service

Maryland telepharmacy provider MedNovations got a write up in the Maryland online Gazette.net because of it's valuable remote pharmacy services for hospitals:

‘‘It’s fairly new,” said Doug Scheckelhoff, the director of Pharmacy Practice Sections for the 30,000-member trade group. In fall 2005, the most recent data available, 12.2 percent of the nation’s hospitals used an off-site pharmacy service, he said.

Keeys, 48, called privately held MedNovations a ‘‘multimillion-dollar company,” but, citing competitors, declined to provide specifics about the company’s finances.

With 28 employees at its Laurel headquarters and a six-employee staff in Westfield, Mass., MedNovations has contracted to provide remote pharmacy services to just under 30 medical institutions in 10 states, including Laurel Regional Hospital and four other hospitals in the Washington, D.C., metropolitan area, Keeys said.

‘‘I see this being a significant model for bridging the gap that’s going to be here for a long time,” he said of a national pharmacist shortage that, as baby boomers being to retire, he expects to only worsen.

Points:

• Telepharmacy can be implemented in hospitals to reduce medication errors that would occur overnight
• 12.2% of hospitals use an off-site pharmacy service, as of 2005, (so it's probably higher now)
• Telepharmacy can be provided from a central location to a number of different states
• More people needing medical care will elevate the need for remote pharmacy services
  

Director of Institute for Rural and Community Health is Proud of University Telepharmacy program

Billy Phillips, vice president and director of the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center, writes in to the Lubbock Avalanche-Journal:

Telepharmacy currently provides pharmacy services to two small rural communities whose residents would otherwise need to travel long distances to fill their pharmacy needs.

...

I am proud to say that the outstanding health improvement programs of the F. Marie Hall Institute for Rural and Community Health and the Texas Tech University Health Sciences Center are robust and continue to make a positive difference.

Idaho to regulate hospital telepharmacy service, Texas to scrap regulation?

Idaho:
From the Idaho Statesman comes this tidbit:

The House and Welfare Committee will consider a bill allowing the regulation of institutional telepharmacy services. Upon adjournment of the House, Capitol Annex, Room 240.

Bill Details:
http://www.legislature.idaho.gov/legislation/2009/H0306.htm


Texas:
On the opposite end of the spectrum, there is a bill pending in the Texas House of Representatives, authored and introduced by Rep. Joe Heflin that will effectively end any progress made on the Telepharmacy-serving-rural-areas front, while skyrocketing the rate of medication errors.

If passed, the act would enable a licensed nurse to both supervise pharmacy technicians in their duties and dispense medication from hospital pharmacies without a pharmacist's check of any kind before the medication is administered to the patient, including an on-site OR a remote electronic check, which is more feasible and affordable than ever with the advent of telepharmacy methods. The bill would affect nearly 100 hospital pharmacies in the state.

Considering his only other item of note regarding public health was to sponsor another bill welcoming members of TORCH and the TRHA to the Capitol, one can hardly wonder who lobbied Heflin for the disastrous Texas House Bill 1924. If this downright scary video is any indication of how legislation passes in Texas, HB1924 should fly through without issue.

Bill Details:
http://www.legis.state.tx.us/BillLookup/Text.aspx?LegSess=81R&Bill=HB1924

Update (April 27, 2009):
The Texas Society of Health-System Pharmacists writes in their latest newsletter:

Meanwhile, HB 1924, which would allow nurses to practice pharmacy in rural hospitals passed second reading in the House of Representatives on Friday, April 24. The bill, developed by TORCH (Texas Organization of Rural and Community Hospitals), which represents small, rural facilities, attempts to place in law rules that the Board of Pharmacy has had on the books for nearly 30 years. It states that “a nurse . . may withdraw a drug or device from the (hospital) pharmacy in sufficient quantity to fill the order”(of a prescriber) when a pharmacist is not on duty. The bill would also place in law the (current regulatory) requirement that a consultant pharmacist review drug distribution not later than 7 days after it is withdrawn by a nurse. While the law would expire on January 1, 2012 (unless re-enacted), the bill establishes a precedent that places in law the right of someone not qualified to practice pharmacy acting in that capacity, makes more permanent a method of practice that is outdated, holds back any effort to provide remote or contemporary consultant pharmacy services from undertaking drug order review and essentially establishes a “second class” of care for patients in small and rural hospitals. It is estimated that the bill would exempt nearly 200 hospitals in Texas from having adequate pharmacy services. TSHP worked to oppose and delay the bill in the House Public Health and Calendars Committees, and plans to continue to talk with TORCH to find an acceptable compromise position or defeat the legislation.

Telepharmacies get another shot in rural Nebraska

Paul Hammel writes about a telepharmacy operation in Nebraska for the World-Herald:

Last year, the Nebraska Legislature passed a bill to allow remote dispensing of pharmaceuticals, to allow small-town hospitals that didn't have 24-hour pharmacy coverage to dispense prescription drugs.

But Cover, of the state pharmacists association, said provisions to allow telepharmacies were taken out of that law. A working group is now being formed to make another run at allowing telepharmacies, she said.

Louderback said he hopes it happens soon. He could add weekend hours at the Wausa pharmacy, and other small-town drugstores could avoid closing.

"Telepharmacies are good medicine for small towns"

Jo Dee Black writes about a local telepharmacy operation in Great Falls/Three Forks, Montana:

The VanCampens purchased Liberty Drug. Justin is a pharmacist.

They also own Railway Drug in Three Forks, which is operated as a telepharmacy, a relatively new program in Montana that allows a pharmacist to oversee a registered pharmacy technician at another site using real time video and audio technology.

"Justin steps in front of a monitor and talks to our technician in Three Forks all day long," said Keri VanCampen.

Montana's telepharmacy program was authorized by the 2005 Legislature and modeled after the one established in North Dakota in 2002. It's a tool to preserve pharmacy services in small towns, said Ann Rathke of North Dakota State University College of Pharmacy.

Fred of CPhTLink.com also shares his commentary on the story.

Telepharmacy helps move error rates 'close to zero'?

Helen Figge of the Pharmacy Informatics Section of ASHP writes in US Pharm:

A telepharmacy system has been described at the University of Kansas Hospital in which the chemotherapy preparation process in the pharmacy's sterile room is monitored by bar coding and a camera that documents key steps. The technician scans the bar code on the chemotherapy drug vial to establish a match in the patient's computerized record. Then, in the sterile prep room, the technician captures an electronic image of the vial label and filled syringe prior to injecting the dose into an IV bag. A clinical pharmacist at a remote location then verifies the identity of the drug, the dose on the pulled-back syringe, the label on the IV bag, and the patient's medication order. This telepharmacy process, an alternative to using a robot, features quality assurance steps that are expected to greatly reduce errors.
...
Given the magnitude of morbidity caused by adverse drug events, including medication errors, it is imperative that systematic approaches be taken to redesign the medication dispensing process to eliminate the potential for error. It is conceivable that the combined application of powerful computer software and pharmacy system automation, including robotics, can bring dispensing error rates down close to zero. With the introduction of monitoring methods such as telepharmacy and SORS, the potential exists to continuously monitor dispensed products for correct product and dose, which could further detect and eliminate errors.

University research group compiles rural Telepharmacy policy brief for Federal Government

The Upper Midwest Rural Health Research Center, a group from the University of Minnesota Rural Health Research Center and the University of North Dakota Center for Rural Health who focus on the quality of rural health care, prepared a policy brief for the US federal government (available here), who will likely use it to set national policy regarding telepharmacy.

The full report's summary:

Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety - Findings from this new report and policy brief describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.

The following pharmacies participated in the data collection:

Arkansas State Board of Pharmacy
Cross Ridge Community Hospital, Wynne, Arkansas
St. Bernard’s Medical Center, Jonesboro, Arkansas
Idaho State Board of Pharmacy
St. Luke’s Wood River Medical Center, Ketchum, Idaho
St. Luke’s Meridian Medical Center, Meridian, Idaho
Minnesota State Board of Pharmacy
Ely-Bloomenson Hospital, Ely, Minnesota
St. Luke’s Hospital, Duluth, Minnesota
Wheatland Memorial Hospital, Harlowton, Montana
St. Vincent’s Hospital, Billings, Montana
North Dakota State Board of Pharmacy
North Dakota State University College of Pharmacy
Heart of America Medical Center, Rugby, North Dakota
Lisbon Area Health Services, Lisbon, North Dakota
Oklahoma State Board of Pharmacy
Atoka Memorial Hospital, Atoka, Oklahoma
South Dakota State Board of Pharmacy
Lead-Deadwood Regional Hospital, Deadwood, South Dakota
Texas State Board of Pharmacy
Envision Telepharmacy, Alpine, Texas
Utah Division of Occupational and Professional Licensing
Allen Memorial Hospital, Moab, Utah
San Juan Hospital, Monticello, Utah
University of Utah
Washington State Board of Pharmacy
Sacred Heart Medical Center, Spokane, Washington
Coulee Community Hospital, Grand Coulee, Washington

Support for this report was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. 5U1CRH03717-02-00.

Rural Washington gets new telepharmacy service, allows for 24/7 pharmacist review

The rural Lake Chelan Community Hospital in the US state of Washington finds new telepharmacy service in Envision Telepharmacy, after their pharmacy director was involved in Sacred Heart Medical Center's 2006 telepharmacy program in Spokane, WA. From the article:

Nielson’s experience at LCCH began three years ago, when she worked with the TelePharmacy program at SHMC. TelePharmacy is a system that, with innovative technology, pairs larger medical institutions or specialty healthcare organizations with rural hospitals that may not have 24/7 pharmacy services. Nielson helped pilot SHMC’s program at LCCH in 2006.

At the time, LCCH purchased two automatic drug-dispensing devices. Those units, each about the size of a packing box for a washer or dryer, were connected to a fiber-optic system of technology, local healthcare workers and outside pharmacists, including Nielson, who communicated with Lake Chelan healthcare workers through video conferencing.

It was the same technology that was used at SHMC, explained Nielson, except that the patient was 165 miles away instead of nine floors up.

...
As SHMC’s program evolved and put less emphasis on its TelePharmacy program, it impacted its service to smaller hospitals like LCCH. Nielson, however, still felt drawn to continue working with rural hospitals. That desire brought her to Lake Chelan on a permanent basis.
...

Although Nielson works full-time at LCCH, she cannot be there 24/7, so she searched for a new TelePharmacy program. She found Envision-Rx, an experienced Texas-based company and developed a partnership with them. Eight pharmacists in the company now provide long-distance pharmacy services to Chelan using the technology LCCH already had in place.

“TelePharmacy bridges the gap so we have 24/7 coverage at our hospital,” explained Nielson. “Pharmacists are available at all times to works with our healthcare providers and answer clinical questions. It’s a cost-effective way to have 24-hour pharmacy services.”

Nielson’s TelePharmacy partners are located in Texas, Bellingham, Wenatchee, Blaine, Indiana and Okinawa, Japan.

In LCCH’s pharmacy department, a physician’s written prescription is scanned by nurses and entered into the computer system to access the patient’s laboratory results and other information. Nielson or one of the TelePharmacy pharmacists reviews the dosage and drug interactions and completes the order entry in the computer. After that, a nurse accesses the approved prescription in the automatic dispensing device.

Throughout the process, the pharmacist monitors the verification process and has complete auditing capabilities and access to the medical records. The pharmacist checks for allergies or adverse reactions and can advise the physician if there is a more appropriate drug currently on the market. He or she may also alert the physician that a lab test is needed to monitor the effects of the medication on the patient.

Hospital Telepharmacy Program Helps Canadian Towns Recover from the Pharmacist Shortage

This is the first mention of hospital telepharmacy in Canada! From the article:

“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.”

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.”

Older Report: Washington, DC hospital benefits from Telepharmacy service

From the paper, published in AJHP in 2002, Sibley Memorial Hospital, a 340-bed acute care facility in Washington, DC acquires telepharmacy service from MedNovations:

An alternative to the traditional 24-hour pharmacy service was discussed in September 2000 by SMH's pharmacy director and officers of the telepharmacy service firm MedNovations, Inc. The pharmacists in the department determined that the current on-call pharmacists could not prospectively review all new medication orders and handle existing duties during the day and evening shifts. Support for using the telepharmacy service was obtained from the hospital's senior administrators and the patient care services, medical staff, risk management, legal, and operations departments. Issues pertaining to patient confidentiality and pharmacy licensure were addressed in provisions of the contract between the hospital and the telepharmacy firm. The new service was approved in March 2001 by the pharmacy and therapeutics (P&T) committee.
...
The telepharmacy service emphasized avoidance of medication errors, timely resolution of gaps in clinical data necessary for proper review of new orders and of missing doses, and enforcement of hospital policies and protocols (e.g., therapeutic interchanges and drug-use restrictions). A physician-pharmacist communication form enabled the telepharmacy service to clarify problematic orders on the morning shift more efficiently. (Occasionally, such orders were not verified or approved by the telepharmacy service, and resolution was not accomplished until the morning shift.)
...
It is likely that cognitive telepharmacy services and remote order entry services will grow. Expanded use of computerization and automation will further fuel the use of telepharmacy as a supplement to onsite pharmaceutical services, especially after hours. As with other pharmacy practice innovations, issues such as pharmacoeconomics and compliance with professional standards, laws, and regulations will need to be further examined as the telepharmacy model attempts to deliver high-quality care and safety in hospitals when pharmacy departments are closed.