1. North Dakota Telepharmacy Project Hospital Telepharmacy Model Slide presentation by John S. Skwiera, R.Ph., Heart of America Medical Center, Rugby

2. What Is Hospital Telepharmacy?  Is it a means to provide access to medications via automation?  Is it a means to provide ready access to medications and professional services? IT CAN BE BOTH!

3. Automation  Pyxis, Omnicell -- automated dispensing equipment  Expensive  Data entry with verification necessary  Is not the answer to everything

4. ND Telepharmacy Model Utilizes the unique skills and knowledge of technicians, nurses, pharmacists, physicians, and related health professionals to optimize the care of the patient while overcoming current and future barriers to patient care Utilizes the unique skills and knowledge of technicians, nurses, pharmacists, physicians, and related health professionals to optimize the care of the patient while overcoming current and future barriers to patient care

5. ND Telepharmacy Model  Recognizes that technology is limited  Recognizes that the practice of pharmacy is still an art  Utilizes people and technology, each one complementing the other in the service of the patient

6. Why Do It?  Maintaining quality of care  Easing pharmacist shortages  Improving of the pharmacist’s life  Maintaining the bottom line  Complying with regulations

7. Pharmacist Demographics  There are not enough pharmacists  We can’t “burn out” the pharmacists we have  Pharmacists in many rural hospitals are aging  Recruitment of young pharmacists to rural areas is lagging

8. Maintaining Quality of Care  Using the best personnel possible for medication order entry, evaluation, and dispensing of medications  THE PHARMACY TECHNICIAN  THE PHARMACIST  Their unique skills and talents complement those of nursing and other health care professionals

9. Easing Pharmacist Shortages  Telepharmacy may be the only feasible option for:  Emergency coverage  After hours coverage  Weekend coverage  Vacation coverage  Routine pharmacy operations

10. Improving the Lives of Hospital Pharmacists  Reducing stress  Assisting in staff retention and recruitment  Keeping open

11. Maintaining the Bottom Line  Staffing a pharmacy with a technician is cost-effective  Pharmacist coverage via telepharmacy may cost less than an on-site pharmacist

12. Complying With Regulations  Stringent CMS and JCAHO guidelines for pharmacist review of orders prior to the administration of any medications, except in emergencies  Possible restriction of access to the pharmacy of non-pharmacy personnel  State and federal regulations

13. Telepharmacy in the Hospital Setting

14. First Steps  Commit to following through!  Seek out partners  Seek assistance from NDSU College of Pharmacy and the ND Board of Pharmacy  Educate administrators, corporate executives, and staff

15. Next Steps  Apply for funding (ND Telepharmacy Project)  Determine components (both hospital and home units) and equipment needs  Develop policies and procedures and business associate agreements/contracts  Choose an internet provider  Obtain bids for equipment, installation, and servicing

16. Telepharmacy Components  Institutional component  Hospital to hospital  Community pharmacy to hospital  Provides services between two sites for scheduled telepharmacy operations

17. Telepharmacy Components Pharmacist’s home to institution for unscheduled absences of a pharmacist due to illness, inclement weather, etc. Pharmacist’s home to institution for unscheduled absences of a pharmacist due to illness, inclement weather, etc.

18. Equipment Needs Equipment Needs  Polycom unit with a document camera (optional at home sites)  Personal computer and/or institutional network access  Equipment and software  Security (VPN, firewalls, anti-virus software) and access  Satellite dish (optional at home sites)

19. Approximate Costs  Polycom VSX, PCs, monitors, high resolution document camera(s), misc.: $12,000+  DSL: up to $150/mo.  Virtual Private Network (VPN): $1,000  Equipment Installation: $1,500+  Software as needed  Remodeling as needed  Counter space: ca. 5 linear feet

20. Paperwork/Documentation  Telepharmacy Policy/Procedure -- establishes standards of pharmacy practice  Business Associate Agreement -- establishes contractual agreements and outlines adherence to HIPAA regulations  Grant requirements -- expense tracking and reimbursement  Error/near-miss tracking

21. Telepharmacy Policy  Must insure maintenance of quality care  Must insure adequate evaluation and verification of technician work  Must incorporate policies for resolving any questions, discrepancies, or errors  Must be in accordance with law to the satisfaction of the Board of Pharmacy

22. Telepharmacy Policy  Can delineate the qualifications and training of staff  Can have anything that the partners want in it (within reason)  Can not contradict current policies within each participating hospital

23. Recommended Reading “Rural Hospitals and Telepharmacy” by Petra S. Berger (Risk Management and Patient Safety Institute) “Rural Hospitals and Telepharmacy” by Petra S. Berger (Risk Management and Patient Safety Institute) www.rmpsi.com www.rmpsi.com

24. The Procedure  Order entry by the technician  Verification of order entry by the supervising pharmacist -- this is accomplished by placing a hard copy of the physician’s order under the document camera and comparing it to the technician’s computer entry

25. The Procedure  Verification of the drug and label by the supervising pharmacist -- this is done by placing the drug and label under the document camera  Release of the drug  Documentation of the transaction by the technician or pharmacist

26. Who Sees What?  Each pharmacist can have access to another site’s pharmacy information system, as allowed by the software -- ideally, it would be compatible  The pharmacist can view and approve a technician’s work at the other sites, as allowed

27. Evaluate

28. Verify

29. Identify Meds

30. Pitfalls  Institutional resistance  Corporate resistance  Staff resistance  Lack of time to implement  Lack of ongoing financial commitment  Challenges in terms of systems compatibility and connectivity

31. Future Possibilities  The addition of sites to existing hospital telepharmacy network  Other hospitals will provide this or similar services  As pharmacists retire in rural settings, expansion may include full time telepharmacy coverage  The servicing of hospitals by community pharmacists without needing to be on site

32. Hospital Telepharmacy Network (as of 9/1/06)  Heart of America Medical Center, Rugby  Mercy Hospital, Devils Lake  St. Aloisius Hospital, Harvey  Towner County Medical Center, Cando  Presentation Medical Center, Rolla  Carrington Health Center, Carrington  SCCI Hospital, Mandan

33. Conclusion  Telepharmacy is a way to provide superior pharmacy services to rural ND  Telepharmacy is adaptable to a wide range of practice settings  This is only the tip of the iceberg in terms of possibilities

34. RESOURCES RESOURCES Ann Rathke, Telepharmacy Coordinator NDSU College of Pharmacy, Nursing, and Allied Sciences 123 Sudro Hall Fargo, ND 58105 701-231-5863 ann.rathke@ndsu.edu

35. RESOURCES Howard Anderson, Executive Director North Dakota Board of Pharmacy PO Box 1354 Bismarck, ND 58502-1354 701-328-9535 ndpoph@btigate.com

36. RESOURCES John Skwiera, R.Ph. Heart of America Medical Center 800 South Main Rugby, ND 58368 701-776-5261, ext 2262 pharmacy@hamc.com

37. Telepharmacy Equipment Ryan Jilek Custom Data, Inc. 677 10th Street East Dickinson, ND 58601 701-483-3036 www.telepharmacyconcepts.com www.customdata.com jilek@customdata.com