North Dakota Telepharmacy North Dakota Telepharmacy ProjectProject
Hospital Telepharmacy Hospital Telepharmacy ModelModel
Slide presentation by John S. Skwiera, Slide presentation by John S. Skwiera, R.Ph., Heart of America Medical R.Ph., Heart of America Medical Center, RugbyCenter, Rugby
What Is Hospital What Is Hospital Telepharmacy?Telepharmacy?
Is it a means to provide access to medications Is it a means to provide access to medications via automation?via automation?
Is it a means to provide ready access to Is it a means to provide ready access to medications and professional services?medications and professional services?
IT CAN BE BOTH!IT CAN BE BOTH!
AutomationAutomation
Pyxis, Omnicell -- automated dispensing Pyxis, Omnicell -- automated dispensing equipmentequipment
ExpensiveExpensive Data entry with verification necessaryData entry with verification necessary Is not the answer to everythingIs not the answer to everything
ND Telepharmacy ModelND Telepharmacy Model
Utilizes the unique skills and knowledge Utilizes the unique skills and knowledge of technicians, nurses, pharmacists, of technicians, nurses, pharmacists, physicians, and related health physicians, and related health professionals to optimize the care of the professionals to optimize the care of the patient while overcoming current and patient while overcoming current and future barriers to patient carefuture barriers to patient care
ND Telepharmacy ModelND Telepharmacy Model
Recognizes that technology is limitedRecognizes that technology is limited Recognizes that the practice of pharmacy Recognizes that the practice of pharmacy
is still an artis still an art Utilizes people and technology, each one Utilizes people and technology, each one
complementing the other in the service of complementing the other in the service of the patientthe patient
Why Do It?Why Do It?
Maintaining quality of careMaintaining quality of care Easing pharmacist shortagesEasing pharmacist shortages Improving of the pharmacist’s lifeImproving of the pharmacist’s life Maintaining the bottom lineMaintaining the bottom line Complying with regulationsComplying with regulations
Pharmacist Pharmacist DemographicsDemographics
There are not enough pharmacistsThere are not enough pharmacists We can’t “burn out” the pharmacists we haveWe can’t “burn out” the pharmacists we have Pharmacists in many rural hospitals are aging Pharmacists in many rural hospitals are aging Recruitment of young pharmacists to rural Recruitment of young pharmacists to rural
areas is laggingareas is lagging
Maintaining Maintaining Quality of CareQuality of Care
Using the best personnel possible for Using the best personnel possible for medication order entry, evaluation, and medication order entry, evaluation, and dispensing of medicationsdispensing of medications
THE PHARMACY TECHNICIANTHE PHARMACY TECHNICIAN THE PHARMACISTTHE PHARMACIST Their unique skills and talents complement Their unique skills and talents complement
those of nursing and other health care those of nursing and other health care professionalsprofessionals
Easing Pharmacist Easing Pharmacist ShortagesShortages
Telepharmacy may be the only feasible Telepharmacy may be the only feasible option for:option for:
Emergency coverageEmergency coverage After hours coverageAfter hours coverage Weekend coverageWeekend coverage Vacation coverageVacation coverage Routine pharmacy operationsRoutine pharmacy operations
Improving the LivesImproving the Lives of of Hospital PharmacistsHospital Pharmacists
Reducing stressReducing stress Assisting in staff retention and Assisting in staff retention and
recruitmentrecruitment Keeping openKeeping open
Maintaining the Maintaining the Bottom LineBottom Line
Staffing a pharmacy with a technician is Staffing a pharmacy with a technician is cost-effectivecost-effective
Pharmacist coverage via telepharmacy Pharmacist coverage via telepharmacy may cost less than an on-site pharmacistmay cost less than an on-site pharmacist
Complying With Complying With RegulationsRegulations
Stringent CMS and JCAHO guidelines for Stringent CMS and JCAHO guidelines for pharmacist review of orders prior to the pharmacist review of orders prior to the administration of any medications, except in administration of any medications, except in emergenciesemergencies
Possible restriction of access to the pharmacy Possible restriction of access to the pharmacy of non-pharmacy personnelof non-pharmacy personnel
State and federal regulationsState and federal regulations
First StepsFirst Steps
Commit to following through!Commit to following through! Seek out partnersSeek out partners Seek assistance from NDSU College of Seek assistance from NDSU College of
Pharmacy and the ND Board of Pharmacy and the ND Board of PharmacyPharmacy
Educate administrators, corporate Educate administrators, corporate executives, and staffexecutives, and staff
Next Steps Next Steps
Apply for funding (ND Telepharmacy Project)Apply for funding (ND Telepharmacy Project) Determine components (both hospital and Determine components (both hospital and
home units) and equipment needshome units) and equipment needs Develop policies and procedures and business Develop policies and procedures and business
associate agreements/contractsassociate agreements/contracts Choose an internet providerChoose an internet provider Obtain bids for equipment, installation, and Obtain bids for equipment, installation, and
servicingservicing
Telepharmacy Telepharmacy ComponentsComponents
Institutional componentInstitutional component Hospital to hospitalHospital to hospital Community pharmacy to hospitalCommunity pharmacy to hospital
Provides services between two sites for Provides services between two sites for scheduled telepharmacy operationsscheduled telepharmacy operations
Telepharmacy Telepharmacy ComponentsComponents
Pharmacist’s home to institution for Pharmacist’s home to institution for unscheduled absences of a pharmacist unscheduled absences of a pharmacist due to illness, inclement weather, etc.due to illness, inclement weather, etc.
Equipment NeedsEquipment Needs Polycom unit with a document camera (optional Polycom unit with a document camera (optional
at home sites)at home sites) Personal computer and/or institutional network Personal computer and/or institutional network
accessaccess Equipment and software Equipment and software Security (VPN, firewalls, anti-virus software) Security (VPN, firewalls, anti-virus software)
and access and access Satellite dish (optional at home sites)Satellite dish (optional at home sites)
Approximate Costs Approximate Costs
Polycom VSX, PCs, monitors, high resolution Polycom VSX, PCs, monitors, high resolution document camera(s), misc.: $12,000+document camera(s), misc.: $12,000+
DSL: up to $150/mo.DSL: up to $150/mo. Virtual Private Network (VPN): $1,000Virtual Private Network (VPN): $1,000 Equipment Installation: $1,500+Equipment Installation: $1,500+ Software as neededSoftware as needed Remodeling as neededRemodeling as needed Counter space: ca. 5 linear feetCounter space: ca. 5 linear feet
Paperwork/Paperwork/DocumentationDocumentation
Telepharmacy Policy/Procedure -- establishes Telepharmacy Policy/Procedure -- establishes standards of pharmacy practicestandards of pharmacy practice
Business Associate Agreement -- establishes Business Associate Agreement -- establishes contractual agreements and outlines contractual agreements and outlines adherence to HIPAA regulationsadherence to HIPAA regulations
Grant requirements -- expense tracking and Grant requirements -- expense tracking and reimbursementreimbursement
Error/near-miss trackingError/near-miss tracking
Telepharmacy PolicyTelepharmacy Policy
Must insure maintenance of quality careMust insure maintenance of quality care Must insure adequate evaluation and Must insure adequate evaluation and
verification of technician workverification of technician work Must incorporate policies for resolving Must incorporate policies for resolving
any questions, discrepancies, or errorsany questions, discrepancies, or errors Must be in accordance with law to the Must be in accordance with law to the
satisfaction of the Board of Pharmacysatisfaction of the Board of Pharmacy
Telepharmacy PolicyTelepharmacy Policy
Can delineate the qualifications and Can delineate the qualifications and training of stafftraining of staff
Can have anything that the partners want Can have anything that the partners want in it (within reason)in it (within reason)
Can not contradict current policies within Can not contradict current policies within each participating hospitaleach participating hospital
Recommended Reading Recommended Reading
“ “Rural Hospitals and Telepharmacy” by Rural Hospitals and Telepharmacy” by Petra S. Berger (Risk Management and Petra S. Berger (Risk Management and Patient Safety Institute)Patient Safety Institute)
www.rmpsi.comwww.rmpsi.com
The ProcedureThe Procedure
Order entry by the technicianOrder entry by the technician Verification of order entry by the Verification of order entry by the
supervising pharmacist -- this is supervising pharmacist -- this is accomplished by placing a hard copy of accomplished by placing a hard copy of the physician’s order under the document the physician’s order under the document camera and comparing it to the camera and comparing it to the technician’s computer entrytechnician’s computer entry
The ProcedureThe Procedure
Verification of the drug and label by the Verification of the drug and label by the supervising pharmacist -- this is done by supervising pharmacist -- this is done by placing the drug and label under the placing the drug and label under the document cameradocument camera
Release of the drugRelease of the drug Documentation of the transaction by the Documentation of the transaction by the
technician or pharmacisttechnician or pharmacist
Who Sees What?Who Sees What?
Each pharmacist can have access to another Each pharmacist can have access to another site’s pharmacy information system, as allowed site’s pharmacy information system, as allowed by the software -- ideally, it would be by the software -- ideally, it would be compatiblecompatible
The pharmacist can view and approve a The pharmacist can view and approve a technician’s work at the other sites, as allowedtechnician’s work at the other sites, as allowed
PitfallsPitfalls Institutional resistance Institutional resistance Corporate resistanceCorporate resistance Staff resistance Staff resistance Lack of time to implementLack of time to implement Lack of ongoing financial commitment Lack of ongoing financial commitment Challenges in terms of systems compatibility Challenges in terms of systems compatibility
and connectivityand connectivity
Future PossibilitiesFuture Possibilities
The addition of sites to existing hospital The addition of sites to existing hospital telepharmacy networktelepharmacy network
Other hospitals will provide this or similar Other hospitals will provide this or similar servicesservices
As pharmacists retire in rural settings, As pharmacists retire in rural settings, expansion may include full time telepharmacy expansion may include full time telepharmacy coveragecoverage
The servicing of hospitals by community The servicing of hospitals by community pharmacists without needing to be on site pharmacists without needing to be on site
Hospital Telepharmacy Hospital Telepharmacy Network Network (as of 9/1/06)(as of 9/1/06)
Heart of America Medical Center, RugbyHeart of America Medical Center, Rugby Mercy Hospital, Devils LakeMercy Hospital, Devils Lake St. Aloisius Hospital, HarveySt. Aloisius Hospital, Harvey Towner County Medical Center, CandoTowner County Medical Center, Cando Presentation Medical Center, RollaPresentation Medical Center, Rolla Carrington Health Center, CarringtonCarrington Health Center, Carrington SCCI Hospital, MandanSCCI Hospital, Mandan
ConclusionConclusion
Telepharmacy is a way to provide superior Telepharmacy is a way to provide superior pharmacy services to rural NDpharmacy services to rural ND
Telepharmacy is adaptable to a wide range of Telepharmacy is adaptable to a wide range of practice settingspractice settings
This is only the tip of the iceberg in terms of This is only the tip of the iceberg in terms of possibilitiespossibilities
RESOURCESRESOURCES
Ann Rathke, Telepharmacy CoordinatorAnn Rathke, Telepharmacy CoordinatorNDSU College of Pharmacy, Nursing, and NDSU College of Pharmacy, Nursing, and
Allied SciencesAllied Sciences123 Sudro Hall123 Sudro HallFargo, ND 58105Fargo, ND [email protected]@ndsu.edu
RESOURCESRESOURCES
Howard Anderson, Executive DirectorHoward Anderson, Executive Director
North Dakota Board of PharmacyNorth Dakota Board of Pharmacy
PO Box 1354PO Box 1354
Bismarck, ND 58502-1354Bismarck, ND 58502-1354
701-328-9535701-328-9535
[email protected]@btigate.com
RESOURCESRESOURCES
John Skwiera, R.Ph.John Skwiera, R.Ph.
Heart of America Medical CenterHeart of America Medical Center
800 South Main800 South Main
Rugby, ND 58368Rugby, ND 58368
701-776-5261, ext 2262701-776-5261, ext 2262
[email protected]@hamc.com
Telepharmacy EquipmentTelepharmacy EquipmentRyan JilekRyan Jilek
Custom Data, Inc.Custom Data, Inc.
677 10th Street East677 10th Street East
Dickinson, ND 58601Dickinson, ND 58601
701-483-3036701-483-3036
www.telepharmacyconcepts.comwww.telepharmacyconcepts.com
www.customdata.comwww.customdata.com
[email protected]@customdata.com