Telepharmacy at Texas Tech Jon Phillips, Associate Director of Telemedicine

Senate Bill 65—Legislation Enabling Telepharmacy A “telepharmacy system” means a system that monitors the dispensing of prescription drugs and provides for related drug use review and patient counseling services by an electronic method, including the use of these technologies Audio and video Still image capture Store and forward

S.B. 65 continued Telepharmacy services provided by a Class A or Class C pharmacy to a health facility at a distant location Distant telepharmacy site may not be located in a community in which a Class A or Class C pharmacy exists Required to be under the continuous supervision of a pharmacist (electronic supervision by audio and video communication) Bullet 2—If the telepharmacy system is in the community first, and a Class A or C pharmacy locates there, then the telepharmacy system may continue to operate in that community.

S.B.65 continued Directs the Texas State Board of Pharmacy to develop rules to govern the operation of telepharmacy services

TSBP Telepharmacy Rules Remote pharmacy services—storage & dispensing of prescription drugs, drug regimen review, and patient counseling at a remote site Sites eligible for remote pharmacy services Rural health care clinic Health care center Health care facility located in a medically underserved area

TSBP Rules cont’d Each pharmacist at the central pharmacy may supervise—electronically—no more than three remote sites that are simultaneously open (exceptions may be granted)

Texas Tech Telepharmacy Pilot Project Collaborative project Texas Tech Sid Ontai – private physician Health Care Visions, Inc.

Texas Tech Telepharmacy Pharmaceutical Care Center at Texas Tech Medical Center Southwest (TTMCSW) serves as the demonstration central pharmacy Evaluating the project Health professional student education and training in rural care Economic feasibility to provide services to rural communities Evaluation of current law to determine if it allows maximum potential of the system

Funding USDA RUS grant to Dr. Ontai for equipment and operations Texas Tech for research and monitoring

Texas Tech Telemedicine service area

Telepharmacy service area

Project Objectives Field test telepharmacy Propose rule changes and improvements Enhance access to medications Training/education

Project information The Turkey Telepharmacy site site is staffed with an Emergency Medical Technician (EMT) from 8:00 AM to 12:00 noon Monday through Friday. Medications available for dispensing at the the Turkey Telepharmacy site were determined by a committee composed of Dr. Ontai and the Director of the Texas Tech Pharmaceutical care and Infusion Center. To conform to security standards, medications at the the Turkey Telepharmacy site are stored in approved, secured medication blister packs

Project information The central computer maintains separate sets of computerized data files. This allows each extended pharmacy to have its own NABP number, drug formulary, inventory, patient, doctor, and prescription files. Communications between the TTMCSW and the Turkey Telepharmacy site are conducted through an encrypted DSL connection.

Educational opportunities -Rural Clerkship- One day with Dr. Ontai in his office in Plainview, Texas. One day at central pharmacy at TTMC SW. Three days with mid-level practitioner at Turkey Rural Health Clinic.

Progress Report 247 total prescription transactions completed as of March 31,2003

Telepharmacy Technology RX filled at a central location, RX label and monograph printed at remote location Thumbnail of medication and scanned NDC / quantity used for verification at Remote Site Final approval of RX completed by pharmacist utilizing Rendezviewer POS Transaction completes sale and records sale

Rendezvous and Rendezviewer Uses store and forward technology Review episodes from you home, office, airport or anywhere you have access to the Internet Proven reports for audits and compliance Allows episodes to be forwarded to multiple healthcare professionals for review and comments

Audit and Reporting Features Inventory Control for Central and Remote Centralized Drug Ordering Cash Register Audit Report Voided Prescription Report Pharmacist Review Time and Date Tracking Patient Compliance Reporting

First Telepharmacy Prescription in the State of Texas Texas Tech Medical Center SW Lubbock, Texas Turkey Medical Clinic Turkey, Texas September 18, 2002

PATIENT SATISFACTION SURVEY QUESTIONS I would rather see a pharmacist on the telepharmacy system than travel to see him or her

PATIENT SATISFACTION SURVEY QUESTIONS If the Telepharmacy system were not available, I would receive my medicine by mail or internet pharmacy

PATIENT SATISFACTION SURVEY QUESTIONS I felt the pharmacist counseling was not adequate because the pharmacist was not showing me my medicine in person

PATIENT SATISFACTION SURVEY QUESTIONS If the Telepharmacy system were NOT available, how many miles would you have to have travel one way to get your prescription?

Project status Project will continue Results very positive Sound science and technology Considering expansion/additional sites

Questions?