Daniel R. HalversonDanH@GrandNet.com

4130 Linden Ave, Ste 305

Dayton, OH 45432937-254-9980

IsoRxTM

TelePharmacy Software

IsoRx

Objectives

At the end of this section, you will be able to:

1. Describe how current and future technologies are integrated to provide high quality pharmaceutical care via telecommunications

2. Identify security issues and protection schemes of VPN for TelePharmacy applications

3. Identify the differences between the TelePharmacy concept and Internet drug stores concept

IsoRx

IsoRxTM Concept

Rx

IsoRx

Scenario “One” - Starting a new drug regiment

Scenario “Two”- Urgent need:

 Scenario “Three”- Extinction of rural pharmacies

Scenario “Four” - Receiving maintenance drugs by mail

Example Needs Scenario • Scenario “One” - Starting a new drug regiment: A mother visiting the rural clinic is told her 8-month-old baby has

otitis media (ear infection) and needs an antibiotic and ear drops. The nearest pharmacy is 40 miles away. She does not have a baby sitter and will need to take a 3-hour, 80-mile trip with her sick baby. The complexity of the situation can be multiplied in the Northern Minnesota winter weather conditions.

•  • Scenario “Two”- Urgent need: It is determined at the rural clinic that an 80 year old woman needs to change from a 5-

milligram dosage of coumadin to a 1-milligram dosage. She has no transportation. The nearest pharmacy is more then 30 miles away. A remote pharmacy can mail out the new 1-milligram dosage but it will not arrive for four (4) days. Coumadin is a critical maintenance drug, which thins the blood. Too low a dose can add to the chance of a heart attack and with too high a dose, a patient can bleed to death from a minor injury. The 80-year-old woman is forced to try to cut the small 5-milligram pill with a razor blade to make the dosage a 1-milligram.

•  Scenario “Three”- Extinction of rural pharmacies: A 66-year-old rural pharmacist has decides to retire. He has worked in the community his whole life. He has been happy with his lifestyle and income. He does an average of 35 prescriptions a day and sells a variety of merchandise to the community. The next nearest drugstore is 40 miles away, nearly a two-hour drive. He makes $50,000 a year and is satisfied with this income. He will close his store. No pharmacist will buy a business and take on the responsibilities of business ownership when they can earn $80,000 annually in urban America as a staff pharmacist.

• Scenario “Four” - Receiving maintenance drugs by mail: The elderly in rural northern Minnesota cannot receive the maintenance drug insulin via mail order for a large percentage of the year. Temperatures in their mailboxes will drop to below zero either breaking the container or

TelePharmacy Concept

- Hardware- Software- Connectivity

RxRx

IsoRx

The Solution

- Pharmacy Technician- Client- Formulary

Staff Pharmacist

History

• Proof of Concept Project (1999)– Concept Developed– Prototype Developed and Integrated– Prototype Tested

• North Dakota (Current Project)– Maddock– ND College of Pharmacy

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TelePharmacy Objectives• Increase Pharmacy Prescription Volume

– Via Telecommunications – Minimize Cost per Transaction

• Maintain Quality Consultations– Personalize Relationship with Local Clients– Apply Same State Certification & Regulations

• Compete With Internet Drug Stores

IsoRx

Proof of Concept Project• Software

• Provide Live Video• Provide Monitoring Pictures

– Prescription - Dispensing Container– Spilled Pills - Final Product

• Hardware• Low Cost• User Friendly• Privacy

• Connectivity• Virtual Private Network• POTS

IsoRx

Applicable Technologies

• Virtual Private Network– Private connection between two machines over public network

• Turns Internet into simulated WAN

– Benefits• Uses Encryption, Authentication, and Access Control for Confidentiality• Local Access, reduces cost

• PC Processing Capability (Pentium-Class Systems)– Capable of handling encryption and decryption tasks for high speed

transmission lines

• Video Capability (High Resolution Cameras)

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Physical Requirements

• Located at Existing Clinics• POTS Telephone Lines (2)• Physical Security • Pharmacy Work Area (Workstation / Counter Space)• Accessibility to the Patients • Patient Privacy(Consulting Environment)

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TelePharmacy Model

Remote Pharmacy

MainPharmacy

Store

STAFFING• 1 RPh• 3 Pharm Techs

PHARMACY STORE PROFILE• 50 prescription per day• Only Pharmacy in area• RPh Staff

REMOTE PHARMACY PROFILE• 20-40 prescription per day• Nearest Pharmacy more than 20 miles away

Remote Clinic

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System DesignArchitecture

Main Pharmacy

Large Display24” +

CPU, P4, 1.5GHz+128 Meg of RAMHard DriveCD read/write3.5 disk DriveSpeakers/mic.Microphone/Head setModem

Camera “One”

•Windows 98

•Visual Basic

•IsoRXTM Software

IsoRx

System DesignHardware Architecture

Remote Pharmacy

Large Display

24” +

CPU, P4, 1.5GHz+128 Meg of RAMHard DriveCD3.5 disk DriveSpeakers/mic.Modem

Camera “Still Pictures”

Camera “Conferencing”

Printer

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ProtocolOverview

• Data Exchange - Rx Submitted • Prescription Reviewed• Spill and fill

• Data Exchange - Rx Validation• Medication and dispensing container reviewed• Label and information sent to the Remote Pharmacy• Peel and stick

• Data Exchange - Rx Consultation• Data Archiving

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Protocol Data Exchange – Rx Submitted

• Patient Submits Prescription / Refill• Pharm Tech takes picture of the prescription• Pharm Tech informs the RPh of the request• RPh reviews prescription and enters data, dosage,

DUR (Patient profile and interactions)• RPh submits claim for processing • Once insurance communications and DUR is

complete the RPh instructs Pharm Tech to spill and count the Rx

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Protocol Data Exchange - Rx Validation

• View and validate drugs being filled

• View and validate dispensing containers

• Final validation by the RPh

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Protocol Data Exchange - Rx Validation

Pharmacy Management Software

- claims - interactions

- dosage - DUR - etc

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Protocol Data Exchange - Rx Validation

• Following RPh Validation

• Label and patient information leaflet is printed at the Remote Pharmacy

• Financial transaction and dispensing of the medication

• Video consultation conducted by the RPh

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Protocol Data Exchange - Rx Consultation

• Video and Audio Link between the RPh and the patient

• Provides exchange of information of dispensed prescription

• Complete all other transactions

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Lessons Learned

• Prescription Numbers – Best if < 120 prescriptions per day/RPh

• Video Conferencing User Interface– Monitor size– Hand held telephone

• Picture file formats

• Number of remote pharmacy cameras

Benefits To Patient

• Provide needed Pharmaceutical Care to Rural Residents

• Eliminates delays in starting a needed drug regiment

• Eliminate patient travel• Time• Expense• Avoid northern weather hazards

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Benefits To Pharmacy

• Provide needed Pharmaceutical Care to Local Residents

• Create viable Pharmacy business model

• Requires Only One RPh to Support Multiple Small Pharmacies

• Minimum Start-up & Operating Costs

IsoRx

Questions

1. Key technologies integrated and applied to the TelePharmacy concept.

2. Features of a VPN? Choose all that applya. Local telecommunication access

b. Uses encryption and decryption to provide security

c. Used only by large corporations

d. None of the above

3. Differences between the TelePharmacy and Internet drug stores?

IsoRx