1. Telepharmacy: an e-Solution for Rural Hospitals Telepharmacy: an e-Solution for Rural Hospitals Jac Davies November 17, 2005 Inland Northwest Health Services

2. 32 hospitals, with over 2500 beds, participating in an integrated information system and utilizing a common Master Patient Index More than 20 clinics receiving hospital, laboratory and imaging data via standard electronic messages More than 200 offices able to view hospital, laboratory and imaging data via a virtual private network. More than 500 physicians accessing patient records wirelessly in hospitals via personal digital assistants 67 hospitals, clinics and public health agencies connected to the region’s telemedicine network

4. Clinical System Usage and Strategy Clinical Docu- mentation EMR Usage Mobile Chart CPOE Readiness Telehealth Rural Access EMR Usage Mobile Chart CPOE Readiness Telehealth Rural Access ED/ Medication History Imaging Systems – Rad, Card, Path/Other INHS/IRM Community Foundation Meditech HIS System Text & Speech Systems Physicians Mercury MD “Mobile” PCI Expert Systems CPOE – Rules and Alerts Regional Telehealth Network Physician Office Systems – Billing and EMR The integrated information system and common MPI gives the region a foundation for innovative tools, including: Computerized Physician Order Entry (CPOE) Clinical Documentation Systems for Nursing Notes Decision-Support Tools Anywhere, Anytime Physician Access to Images Remote Consultations and Support for Rural Residents

5. INHS Telehealth System Nursing education with universities and community colleges addressing Nursing Shortages Rural hospital TelePharmacy program providing remote Pharmacist services TeleER program remotely assisting rural trauma doctors with ER cases Physicians provide remote Clinical Consults in Neurology, Pathology and many other areas Prison Health Services receive specialist care Statewide Diabetes Education Program Including Native American Tribes

6. TelePharmacy The provision of pharmaceutical care through the use of Telemedicine technology, automated dispensing technology, scanning technology and integrated computer systems

7. Goals of Telepharmacy Program Enhance Patient Safety Compliance with State Board of Pharmacy regulations Efficient use of Pharmacist resources Alleviate Health Care Personnel shortage Improve Patient Outcomes Improve Financial Outcomes

8. Linking Technology to Improve Rural Health Care Videoconferencing Electronic Medical Records Automated Dispensing Devices TelePharmacy

9. Orders are sent to main pharmacy utilizing scanning devices

10. Scanned Image

11. Pharmacist reviews orders received Accuracy of order entryAccuracy of order entry AppropriatenessAppropriateness DosingDosing AllergiesAllergies InteractionsInteractions Disease stateDisease state

12. Consultations can be done via telehealth video link

13. Medication dispensing by automatic dispensing devices

14. ADD* Restocking The utilization of a remote camera and telehealth technology to oversee automated dispensing device* (ADD) restockingThe utilization of a remote camera and telehealth technology to oversee automated dispensing device* (ADD) restocking

15. Fill Lists Technician will print ADD fill list & scan copy to remote pharmacist Technician will pull needed medication from inventory in the pharmacy

16. Restocking Pharmacist visually insures with the technician that the medication is placed in the proper location in the automated dispensing device

17. Medication Verification Pharmacist will visually observe and verify name, strength, dosage form and quantity restocked in automated dispensing device.Pharmacist will visually observe and verify name, strength, dosage form and quantity restocked in automated dispensing device.

18. Accomplishments Five rural hospitals now have experienced hospital pharmacists providing 24/7 coverage. Two more hospitals are joining the program in the next three months. Telepharmacists have intervened in 3% of each rural hospital’s 60,000 to 100,000 annual medication orders to avoid errors. Participating hospitals have seen improved charge capture of $50,000-100,000 / yr / facility. All facilities are now in full compliance with Pharmacy Board regulations.

19. Urban/Rural Technology Value Model Rural Patient

20. Thank You! Daviesjc@inhs.org www.inhs.org