Telepharmacy Takes CPOE To the Next Level

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Does your hospital provide off-site pharmacist support at 3am? In the era of CPOE, new tele-pharmacy services are helping to reduce medication errors.

Ninety-seven percent of hospitals use hospital-based computerized physician order entry (CPOE) systems, thanks in part to a 2009 stimulus bill that tied funding to CPOE adoption. But while CPOE has been shown to reduce medication errors, a recent report by Castlight Health and the hospital rating organization Leapfrog Group, showed that CPOE systems failed to flag 13% of potentially fatal medication errors. In this increasing digital healthcare eco-system, what role can tele-pharmacy play in helping ensure medication security and safety.

The problem has become all too common. It’s the middle of the night and a physician working in the emergency department is entering orders into the hospital’s computer system. Because of the late hour, there’s no pharmacist on site, so the orders get transmitted directly to the cabinet where a nurse manager could override them. From a clinical perspective, this is asking nurses to take on the tasks of a pharmacist in addition to their patient care duties. This is both unwise and unfair to nurses.

Some hospitals have chosen to implement telepharmacy in conjunction with their CPOE system, to ensure that a clinical pharmacist is always verifying any medication orders as soon as they are prescribed. Even when reviewed off-site, having a set of clinically trained eyes on these medication orders adds another level of security and safety for patients and providers. Thanks to expanding telepharmacy options, this can be a pharmacist in the hospital’s network who may be working from one central location but monitoring several ancillary sites during non-peak hours, or an external service provider. Although the majority of U.S. states today allow for this type of unique clinical support, it isn’t available in all states as the practice of telepharmacy continues to fight through some legislative roadblocks.

The regulatory landscape for telepharmacy varies widely from state to state – some states are highly regulated while others have nothing on the books. Professional organizations like the National Association of Boards of Pharmacy have tried to spur uniform legislation by developing a definition of the ‘practice of telepharmacy’ through its Model Pharmacy Practice Act, but regulation still remains inconsistent across state lines. As states look to develop their own guidelines, they sometimes fail to consider the full breadth of solutions and applications that exist under the umbrella of ‘telepharmacy’ and the differences between retail and hospital models. There are several models and technologies to leverage in telepharmacy – there’s no one-size-fits-all approach. Additionally, with the pressure on hospitals to bring value to patients increasing, we will see the lines between direct-to-consumer and peer-to-peer practice blur as telepharmacists help verify medication orders, but also perform discharge planning or additional patient facing activities that may help reduce readmissions or manage chronic illnesses.

Brian Roberts is the CEO and co-founder of PipelineRx, a medication management services and technology company, based in San Francisco, California.

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