Unlike years past, it’s not as financially feasible to operate a traditional retail pharmacy in rural and underserved communities. To help combat this challenge, pharmacists are using new telepharmacy technology to serve patients who struggle with pharmacy access.
In 2002, North Dakota became the first state to allow telepharmacy, or the dispensing of prescription medicines from a location with no pharmacist physically present. After a successful pilot program supporting four locations, the state now has 81 remote sites serving more than 80,000 rural citizens in about three-quarters of its counties, who might otherwise be without pharmacy service.1
Demand for Telepharmacy
Telepharmacy is not only stemming the tide of pharmacies closing in low-population regions, but it also gives independent pharmacists a new way to expand business and serve more patients than before. In December 2016, a community telepharmacy opened in Shoshone, ID, providing roughly 1,500 residents their first pharmacy in 15 years, a welcome alternative to long drives or mail-order solutions.2
“A primary benefit of telepharmacy is to extend the reach of our pharmacists into communities that otherwise would not be possible,” said Brett Barker, Pharm.D., vice president of Operations at NuCara Management Group of Conrad, IA. “We have seen the large impact we can make with patient care in rural communities through telepharmacy.”
Pharmacists are using telepharmacy to serve rural patients living in “pharmacy deserts,” communities located 10-plus miles in driving distance from the nearest retail pharmacy. Beyond the rural use case, underserved urban patients also struggle to access a pharmacist. According to a study in the journal Health Affairs, from 2000-2010, white communities in Chicago gained 20 percent more new pharmacies, while minority neighborhoods saw no increase.3
Telepharmacy is also being tested in other healthcare environments. Integrated Delivery Networks (IDNs) are using telepharmacy as a way to smooth medication-dispensing demand between facilities and to free up pharmacists’ time for improving patient outcomes.4 Recognizing that quick, convenient refills improve medication adherence, two pharmacists affiliated with an organ transplant program at NewYork-Presbyterian Hospital pioneered their own telepharmacy solution. It received immediate approval from lifelong patients versus having to make repeated return trips to the hospital.5
Telepharmacy does not decrease the personal feel of independent and community pharmacies, and it’s more personal than mail-order pharmacy and more regulated than internet orders, said Adam Chesler, Pharm.D. of telepharmacy software vendor TelePharm. “Pharmacists practicing telepharmacy comment to us that they are able to develop a relationship with the patients they otherwise wouldn’t be able to,” he said. The similarity with traditional dispensing helps explain this.
The Details
Operations. The requirements for a telepharmacy operation largely mirror those of a traditional pharmacy: front-end space, a stock of medication, computers equipped with pharmacy management system software and a certified pharmacy technician. The major difference is that no pharmacist is physically present at the location. Instead, new technologies enable the offsite pharmacist to supervise medication dispensing and speak with patients as requested or required.
The telepharmacy workflow is also similar to traditional dispensing: prescription adjudication happens in the pharmacy management system, and then a technician prepares the medication for review by the pharmacist. To facilitate approval, the technician captures images of the prescription, medication label, drug, medication bottle and whatever else is requested by the pharmacist. The pharmacist (located at a traditional pharmacy, or managing site) then reviews the images and references the patient’s full medication profile. The pharmacist also conducts an interactive patient counseling session through a live video connection on a tablet computer.6
Reliable certified pharmacy technicians are crucial to the success of a community telepharmacy. As the on-site face of the pharmacy, technicians should be screened for attention to detail, critical thinking, commitment to learning, initiative and customer service skills. “Telepharmacy requires a highly skilled and competent technician that is able to use technology, have great patient relationships and … be a self-motivator and problem solver,” said Barker.
Regulation. While the North Dakota Telepharmacy Project pioneered administrative rules for telepharmacy, regulation remains a complicated issue. Where telepharmacy is allowed, states’ rules are a patchwork of requirements about setting, staffing and record keeping.7
Last October, the National Association of Boards of Pharmacy (NABP) task force on telepharmacy regulation reviewed its existing Model Act and recommended changes. These updates included a new section discussing licensure, staffing and the handling of drugs at remote locations. The task force amended its definition of telepharmacy to recognize both rapid advances in technology and practice across state lines.8
Chesler said that pharmacists contemplating a telepharmacy must be certain it’s legal in their state and become familiar with the state’s language about specific practice, whether community, retail or outpatient. The NABP website contains a list of state links to begin learning more.
Technology. By definition, technology is a core component of telepharmacy. The remote location needs a pharmacy management system, point-of-sale and a telepharmacy system. Hardware solutions from telepharmacy’s original incarnations face some challenges in today’s environment, such as expensive repair or replacement as they degrade over time. In contrast, software-based solutions generally provide functionality that increases over time as developers work to evolve the software with constant updates. Similarly, cloud-based technology provides an alternative to labor-intensive servers. The cloud also allows for multiple pharmacist-to-pharmacy connections.
According to Chesler, the image-based workflow of today’s telepharmacy software has significantly improved efficiency and safety compared to a live-video workflow, which can feel cumbersome. This is because a live-video workflow requires the pharmacist and technician to be on the same screen at the same time. Images also provide a complete audit log and audit defense. For patient counseling, telepharmacy systems usually rely on a HIPAA-compliant high-definition live video feed.
Deciding to Do Telepharmacy
Unique regulatory issues and technology choices are part of venturing into telepharmacy, but applying a mindset of innovation is also important. “Pharmacists and technicians need to be open to new ways of operating in order for a telepharmacy program to be a success,” said Chesler.
A main reason to consider telepharmacy is the desire to expand business with a smaller initial investment than needed by a traditional store. Dave Falk, owner of Sav Mor Pharmacy locations in Illinois, considers the business model a “no brainer” compared to opening a traditional store in low-volume locations. He cites the example of one of his telepharmacies becoming profitable after only two months’ operation, compared to the two or three years it can take a traditional store.9 Barker said, “The technology also allows a hybrid telepharmacy model with a part-time pharmacist on site and full-time patient access. Telepharmacy can provide the community a pharmacy dispensing base that supports additional clinical services provided by pharmacists, such as immunizations and medication therapy management.”
In addition to opening a brand new telepharmacy location, pharmacists and pharmacy owners might consider acquiring underperforming stores or stores with a retiring pharmacist-owner not likely to make a sale to a new on-site pharmacist.
Just remember that the buy-in of the area’s population is a critical factor for the success of a new community telepharmacy. Chesler said, “If you’re opening a telepharmacy in a small community, make sure the community is on board”– but he reminds pharmacists that patients generally fully embrace the model after being introduced to it.
Sources:
1 History and Progress of HRSA/OAT Telepharmacy Funding. North Dakota State University: Telepharmacy. n.d. Web. 26 July 2017. https://www.ndsu.edu/telepharmacy/history
2 Wootton, Julie. Phoning It In: Telepharmacy Connects Rural Patients. Magic Valley News. January 19, 2017. Web. 26 July 2017. www.magicvalley.com/news/local/phoning-it-in-telepharmacy-connects-rural-patients/article_2d27e4d6-efc3-5059-9dc9-23ef84dfe8b9.html
3 Hostettler, Sam. Nearly 1 Million Chicagoans Live in Pharmacy Deserts. UIC News Center. February 3, 2015. Web. 26 July 2017. www.news.uic.edu/nearly-1-million-chicagoans-live-in-pharamcy-deserts
4 Roberts, Brian. Telepharmacy: Not Just for Rural Hospitals. August 30, 2016. Web. www.pipelinerx.com/blog/telepharmacy-models/#.WQuG_1XyuUk
5 Sweeney, Evan. How Two NewYork-Presbyterian Pharmacists Tapped into Telehealth to Improve Care for Transplant Patients. May 24, 2017. Fierce Healthcare. Web. 26 July 2017. www.fiercehealthcare.com/mobile/how-two-new-york-presbyterian-pharmacists-tapped-into-telehealth-to-improve-care-for
6 Schladetzky, Zach. How Telepharmacy Works: 4 Simple Steps. May 19, 2017. Web. 26 July 2017. blog.telepharm.com/how-telepharmacy-works-4-simple-steps
7 Compton-Brown, Anne, JD and Mooradian, Serj, JD. State Regulation of Telepharmacy. Pharmacy Times. March 23, 2016. Web. 26 July 2017. www.pharmacytimes.com/news/state-regulation-of-telepharmacy
8 National Association of Boards of Pharmacy. Report of the Task Force on the Regulation of Telepharmacy Practice. Oct. 24-25, 2016. Web. 26 July 2017.
www.nabp.pharmacy/wp-content/uploads/2017/05/2016_2017_TelepharmacyTF_Report.pdf
9 Schladetzky, Zach. How to Grow Your Pharmacy: A Telepharmacy Q&A. November 22, 2106. Web. 26 July 2017. blog.telepharm.com/how-to-grow-your-pharmacy-business-with-telepharmacy
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