Telepharmacy spreading in the community setting

Drug Topics, Nov 7, 2005

By: Fred Gebhart

Get set for the next wrinkle in pharmacy services—telepharmacy. Organizations as large as the Department of Veterans Affairs and as small as two friendly pharmacists are using telepharmacy to expand their professional reach.

"Telepharmacy has worked well to bring pharmacy services to places that have not had a pharmacist, sometimes for years," said Howard Anderson, executive director of the North Dakota State Board of Pharmacy. "Even stores with full-time pharmacists are using telepharmacy to cover for one another. Telepharmacy is the most successful pharmacy regulation I have ever been involved with."

Iowa, Montana, Texas, Vermont, and Wisconsin also allow telepharmacy, according to ScriptPro, a pharmacy automation firm in Kansas. Alaska, Arizona, Idaho, Oregon, Utah, Virginia, and Washington have also addressed remote dispensing, said Carmen Catizone, executive director of the National Association of Boards of Pharmacy. "We are comfortable with telepharmacy with the proper safeguards," he said. "The discomfort comes when it is implemented not to extend services to remote locations, but to try to eliminate pharmacy jobs."

Few states actually prohibit the practice of pharmacy with data, voice, and video links, according to ScriptPro president Michael Coughlin. But some require that a pharmacist be physically present to supervise a technician and counsel patients. "I'm seeing a lot of openness at NABP and state boards," he said. "They see this technology as a powerful boost."

Wyoming changed its practice act to allow telepharmacy in 2004. "Now we accept direct supervision as long as the pharmacist and tech have direct, real-time voice and visual communication," said James Carder, executive director of the state's pharmacy board. "We've got a number of small communities that will benefit directly from telepharmacy."

Wyoming requires that telepharmacies be located in a medical clinic or community health center with a licensed prescriber on site. The telepharmacy must be at least 25 miles from an existing pharmacy and must dispense in unit-of-use packaging. Prescriptions are prepared by a pharmacy tech.

An R.Ph. must review the Rx and visually check the products being dispensed, then counsel the patient. There are no specific technology requirements beyond the basics of real-time voice and video links to review the Rx, communicate with the technician, and counsel the patient.

North Dakota's first telepharmacy, which went into effect in 2001, has more liberal rules. The remote site must be inspected by the pharmacy board and maintain always-oncomputer, video, and audio links. That usually means a scanner, video camera, and microphone hooked to a virtual private network or a Web site behind a firewall, Anderson said.

Some telepharmacies use dial-up phone services. Most opt for faster DSL service, which costs about $200 monthly. "It is just as clear as if you were standing next to the tech," Anderson said. "Better, in fact, because you can zoom in with the digital camera to get a better view of the product. Your eyes can't do that."

Pharmacist counseling is required on all Rxs. Packaging and distribution are handled by a pharmacy tech, who must have passed an ASHP accreditation course or equivalent training.

What started as a single pharmacy in 1999 has grown to more than 50 outlets across North Dakota and adjacent states, Anderson said. Only six of North Dakota's 47 hospitals have 24-hour pharmacy service on site, but many have 24-hour telepharmacy service. Thrifty White, a pharmacist-owned regional chain, has established several telepharmacy outlets, as have independent pharmacies.

ScriptPro offers an integrated hardware and software system that runs over DSL or faster service. The firm spent three years refining telepharmacy with the VA, which uses ScriptPro to service community-based outpatient clinics, or CBOCs.

"It's even better than having the patient on the other side of the counter," said VA pharmacist Mickey Andrews, who uses the ScriptPro system. "Patients pay better attention to counseling on screen because there are fewer distractions. It's futuristic, but it lets you extend personal service to remote areas."