Connected: Telepharmacy Unites the Team

Telehealth and telepharmacy originated in rural areas where local, community pharmacies are miles apart. Patients in areas without local communities or clinics are able to receive prescriptions verified by pharmacists through the use of telemedicine technology.

Telehealth delivers healthcare services and information via a variety of telecommunication technologies. Telepharmacy, according to the National Association of Boards of Pharmacy (NABP), is defined as the provision of pharmacist care from a distance to patients through the use of telecommunications and other technologies.

Mark Hardy, PharmD, executive director of the North Dakota Board of Pharmacy, says telepharmacy has an impact on employment opportunities for pharmacists.”It has opened up more practice settings that pharmacists can use,” he said. “Access to healthcare is an issue for us in the Midwest and in rural areas, and using services like this is important to ensure that patients have access to care across these states.”

Rural Telepharmacy

Allie Woods, PharmD, director of ASHP’s Section of Pharmacy Informatics and Technology, said while telepharmacy originated in rural areas with a limited workforce necessary to meet community demands, it is also being used to support medication use in more and more health systems. “Telepharmacy can be used wherever there is not a pharmacist physically present to help provide the quality of care that’s needed.”

Adam Chesler, PharmD, vice president of pharmacy services at TelePharm, said that demand for telepharmacy has grown. “As technology has advanced, telepharmacy has become a reality. Demand for rural access to healthcare has skyrocketed,” he said. NuCara, a community pharmacy chain based in Conrad, Iowa, uses TelePharm’s software. Brett Barker, PharmD, vice president of operations, said that the telepharmacy component of the business has been a “great success.”

Telehealth is a great way for smaller clinics to get around an inability to fund a full-time pharmacist at their location. “However, we still want those patients to have access to patient-care services provided by a pharmacist, and we still want to ensure that they have an efficient means to fill their prescriptions,” said Steven Rough, MS, RPh.

According to Rough, remote dispensing via telepharmacy is a real asset in these types of situations. “We are able to establish remote dispensing sites with an onsite pharmacy technician in these clinic locations. The technician can dial in the pharmacist from an offsite location via remote video technology to confirm that the right drug is being dispensed and to teach patients about their new medications and emphasize the importance of adhering to their regimens. This provides a very cost-effective means for optimizing patient care,” said Rough.

Telepharmacy at Rome Memorial Hospital

At Rome Memorial Hospital, a 130-bed community hospital in Rome, N.Y., Director of Pharmacy Scott Burns, RPh, considered expanding the pharmacy to 24 hours, but it just wasn’t cost-effective. Instead, he turned to a telepharmacy solution from San Francisco-based PipelineRx to cover the pharmacy during off hours.

PipelineRx pharmacists worked in together with hospital IT personnel to gain access to a patients’ electronic health record (EHR) remotely and review medication orders. “PipelineRx is an extension of the in-patient pharmacy department. They follow the same policies and procedures as they would if they were in-house,” Burns said.

Barriers to Telepharmacy

Despite several advances in the field of telehealth and telepharmacy, barriers to growth in the field exist. Identified at a special session run by Rickert and Phil Wickizer at the 2016 American Pharmacist Association, the barriers to growth include:

  • Payment issues. Payment can be problematic in dealings with both governmental and private payers.
  • Licensure. Practicing across state lines and confusing licensure legislation impedes the ability to offer telehealth services.
  • Online prescribing. Physicians must be able to prescribe medications to patients treated through telehealth, but currently in most states patients must be physically examined before a medication can be prescribed.
  • Security concerns. How telehealth services relate to existing legal and regulatory rules pertaining to privacy and security must be determined.

Rickert and Wickizer also touched on how regulators are reacting to telemedicine and telepharmacy, noting that in 2013, the FDA “issued guidance on how they intend to regulate the emerging world of medical applications that have the ability to impact patient health and safety.”

“As the public becomes more aware of the types of telehealth and telepharmacy services available, and as regulators begin recognizing the usefulness of some of this technology, I think you are going to see more and more states get on board. Anything that can improve access to healthcare and pharmacy services can improve patient care, and should be embraced by regulators who are charged with protecting the public,” Rickert said.

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