Telepharmacy is only beginning to scratch the surface of its full potential as a tool for improving patient care and optimizing the pharmacy workforce.
Written by Brian Roberts
While telepharmacy has a long history – Australia’s Royal Flying Doctor Service used a radio consultation to verify the administration of medications to a remote patient in 1942 – it wasn’t utilized in the United States until the 2000s. In the last fifteen years, healthcare has seen two broad applications of telepharmacy, hospital-based and community-based, each carrying unique challenges and opportunities.
Structured from early successful teleradiology models, the hospital application of telepharmacy involves remote verification from a licensed clinical pharmacist for a prescription ordered by a healthcare provider. As automated dispensing cabinets become increasingly common in U.S. hospitals, facilities need this 24/7 verification to ensure nurses are dispensing medications that are safe for the patient, rather than overriding medications at the cabinet and discovering a problem when it’s too late. In rural areas, recommended 24/7 coverage is often unavailable as trained clinical pharmacists may be attracted to larger urban centers. Telepharmacy allows these hospitals to outsource to a third-party company or “share” a pharmacist between sites, decreasing the cost for the facility and providing telemonitoring for other facilities.
Telepharmacy also enables hospitals to better manage their staffing levels during natural ebbs and flows in pharmacy workflow. For instance, following a morning medication pass, the pharmacy may receive a spike in the number of prescription requests to be filled. Rather than staffing for this level, hospitals are able to maintain a mean-level of pharmacists, filling in when needed with remote services. As electronic health records become mainstream, telepharmacists also have the ability to interface directly into hospital health information systems or patient records, ensuring they have the most accurate information possible before making any medication decision.
Telepharmacy enables hospitals of all sizes to better use their onsite pharmacists for patient care activities. The role of the pharmacist continues to evolve to that of a care provider, and the ability to receive reimbursement for direct patient care provided by a hospital pharmacist grows. Whether it be discharge counseling or medication reconciliation, numerous studies show that on-site pharmacists can be better utilized on hospital floors rather than remaining in the pharmacy to verify medication orders.
Following the recession of 2007-2008 the number of independent pharmacies in rural areas decreased, leaving patients in rural areas without many services including medication counseling. In conjunction with Medicare reimbursement changes, community pharmacists weren’t able to maintain their practices despite the increasing role for pharmacists as care providers.
In 2001, North Dakota became the first state to allow retail pharmacies to operate without requiring a licensed pharmacist to be physically present. Instead, a pharmacy technician staffs the facility, with a fully licensed pharmacist available remotely to answer any questions and verify medication orders. In this simple way, many retail pharmacies can share the services of one centrally located pharmacist.
This system was implemented in the U.S. Navy in 2010 as the largest telepharmacy implementation at that point. A supervising pharmacist off-site can view original prescriptions, offer video consultations, and remotely distribute medications (which are visually verified with another camera on-site) to patients onboard the ships.
Telepharmacy is growing, but the available technology is still underutilized. While the proof points for patient safety are well developed, the industry is now becoming more nuanced, exploring potential benefits of telepharmacy from an operational standpoint. Recent legislation has been promising, as it redefines the role of the pharmacist as a car provider, particularly in rural areas, allowing these providers to receive Medicare reimbursements for telepharmacy.
Telepharmacy is in its infancy, but it’s an idea whose time has come. Whether that means integrating remote pharmacists into patient bedside consultations, or offering home consults for patients in extremely rural areas, the options are broad, with many more applications yet to be explored.
Will the rise in telepharmacy reduce our need for pharmacists?
Surprisingly, and perhaps counterintuitively, telepharmacy doesn’t reduce a need for pharmacists, but allows for a reallocation of labor. Rather than spending a shift verifying medication orders or filling prescriptions, the on-site pharmacists are able to be more involved in other clinical activities, which will in turn improve patient outcomes, reduce readmissions, and improve hospital clinical activity and profits. The ASHP practice model actually favors bifurcating order entry and verification from clinical services and working with care teams. While there is the potential for rural hospitals to reduce their labor costs by staffing to a mean level, rather than consistently staffing for peak order times, telepharmacy also provides clinical pharmacist coverage to facilities that may have had periods of no coverage before due to cost restraints. Because a telepharmacist can generally cost a hospital less than staffing for a full- time employee due to the ability to have labor sharing between facilities, it makes 24/7 pharmacist coverage more attainable. This is a very important service for hospitals that have recently implemented CPOE (Computer Physician Order Entry) and need real time verification. By providing this additional coverage, telepharmacy may actually be adding staffing when there was previously no pharmacist covering that shift. Given that 24/7 coverage is a recommendation of the Joint Commission, anything that makes this a more attainable goal for hospital pharmacies is a step in the right direction.