Transcript Implementing Telepharmacy in North Dakota: Saving

The North Dakota Telepharmacy Project
Restoring and Retaining Pharmacy Services
in Rural Communities
Charles D. Peterson, Pharm.D.
Dean & Professor
College of Pharmacy
Sandy Sprafka, Information Tech Services
North Dakota State University
Fargo, North Dakota
North Dakota Demographics
2000 Census Highlights
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642,200 population, ranks 47th in nation
Population growth 0.5% (1990-2000)
Population shift from rural to urban
Only 6 of 53 counties gained population
50% of ND counties lost at least 10%
27 of 53 counties classified as frontier
14.7% over 65, vs 12.4% nationally
Pharmacy Services in ND
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Of the 373 cities, 73 have pharmacies
Of the 53 counties, 9 do not have a
pharmacy and 11 have only one Rx
North Dakota 51% ownership law
North Dakota Rural Health Care Crisis:
Community Pharmacy Closings
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26 rural community pharmacy closings
12 additional pharmacies at risk of closing
Pharmacist retirements - no replacement
National pharmacist shortage
Negative impact on rural health
Exploring Solutions:
Telepharmacy Rules
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Required changes in pharmacy practice act
Telepharmacy rules established by NDBDPh
Pilot project in 2001  permanent rules
established in June 2003
Allow pharmacists to supervise a technician at
remote site within 50 miles
Dispense prescriptions
Pharmacist - patient consultation
Telepharmacy Grant Awarded
NDSU College of Pharmacy
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Congressionally mandated federal grant via the
support of Senator Byron Dorgan
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Office for Advancement of TeleHealth, Health
Resources and Services Administration of HHS
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First Initiated: September 1, 2002
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$1,671,621 federal support to date
Goals of Telepharmacy Grant:
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RESTORATION - restore pharmacy services in
rural communities which have lost their services
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RETENTION - retain pharmacy services in rural
communities which are at risk of losing their services
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Telepharmacy
Project Partners
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NDSU College of Pharmacy
North Dakota State Board of Pharmacy
ND State Pharmaceutical Association
Licensed rural community pharmacies
Targeted rural communities
Telepharmacy Grant Budget
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Assist in the telepharmacy start-up costs
50% OAT Grant/50% North Dakota
Technology: Hardware, Software, Connectivity
Registered Pharmacy Technician
Pharmacy Fixtures
Drug Inventory
Travel
Pharmacy Technician Responsibilities:
Remote Telepharmacy Site
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Maintains drug inventory at remote site
Processes all prescriptions orders including
controlled substances
Computer order entry, filling, billing, labeling
Takes original prescription orders by phone
Prepares prescription for dispensing by
pharmacist
Connects patient to the pharmacist for private
consultation via audio and video link
Technician Training Requirements:
Telepharmacy Sites
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Registered with Board of Pharmacy
ASHP accredited program or equivalent
Minimum of one year experience in
dispensing prescriptions
Salaries are $15/hour or more
Reciprocity from other states requires
PTCB certification
Pharmacist Responsibilities
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Final check of technician Rx preparation
Dispenses drug to the patient
Drug utilization review
Patient education counseling
Demographics:
Remote Telepharmacy Sites
Site
Beach
Rolette
New
England
Maddock
Gwinner
Population
1,116
538
555
498
717
Distance Central Rx
95 miles
32 miles
60 miles
48 miles
10 miles
Date
Operational
Sept. 18,
2002
Nov. 2,
2002
Nov. 26,
2002
May 21,
2003
June 18,
2003
Size of
Pharmacy
1,400
sq. ft.
2,000
sq. ft.
1,200
sq. ft.
2,500
sq. ft.
575
sq. ft.
Full Service
Pharmacy
yes
yes
yes
yes
no
Demographics:
Remote Telepharmacy Sites
Site
Beach
Rolette
New
England
Maddock
Gwinner
Rx ‘s
dispensed
per day
35-40
10-15
25-30
50-55
13-15
Hours of
service
8:30 – 5:00
pm, M-F
9:00 – 5:30
pm, M-F
8:30 – 5:00
pm, M-F
9:00-5:30
pm, M-F
9:00 – 5:00
pm, M-F
# People
employed
1.5 FTE’s
tech/clerk
3 FTE’s
with 3
people
2 FTE’s
with 3
people
3 FTE’s
with
4 people
1.5 FTE’s
tech/clerk
Medical
Coverage
Clinic
5d/wk PA
Clinic 3-4d
/wk PA/MD
Clinic
5d/wk MD
Clinic 5d
/wk PA/MD
Clinic 5d/
wk PA/MD
Benefits to North Dakota with
the Telepharmacy Program
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Improved access to health care for rural citizens
Provides rural economic development
Improved quality of care/pharmacist consults
Increased patient & pharmacist satisfaction
Increased financial viability of rural pharmacies
Provides relief for pharmacists for vacations, etc.
Increased educational opportunities for students
Increased retention of pharmacy graduates
Economic Impact of Telepharmacy
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Has added a $500,000 per year business to
the rural community
Thus far, has added an estimated total of
$7.5 million annually to the North Dakota rural
economy
Has added an estimated 30-40 new jobs to
the North Dakota rural marketplace
Has added 50% increase in prescription sales
to combined pharmacy operation
Economic Development
Add’l Benefits of Telepharmacy
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Helps attract other businesses and
families to community because basic
health care infrastructure is present
Pharmacy can be used for other
business retailing not currently available
within the community
Pharmacy Student Involvement
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Incorporate telepharmacy technology in
NDSU’s new Concept Pharmacy Lab
Trains students on the latest advances
in pharmacy technology
Teaches students how to deliver
pharmacy services in a unique and
innovative way to smaller rural
communities
Student Activities
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Provide pharmacists at the Central
Pharmacy with drug information and
disease state management assistance
Provide patient education counseling to
remote telepharmacy sites
Future Goals of
Telepharmacy in North Dakota
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5-10 new community sites each year
50 telepharmacy sites in five years
Develop a model for serving rural hospitals
Assist other states in implementing
telepharmacy services in rural areas
Establish a state-wide data & video network
Establish equipment standards
Recent Publication
If you would like more information:
Peterson, CD and Anderson HC. The North
Dakota Telepharmacy Project: Restoring and
Retaining Pharmacy Services in Rural
Communities
J. Pharm. Tech 2004:20:28-39
From the technical side ….
Project parameters
 Independent,
privately owned
businesses
 Keep
 Keep
costs down
prescription processing separate
from consultation
Independent Pharmacy Clusters
Issues to Address
HIPAA
 Authentication
 Secure connections
 Reliability
 Internet1
 Costs
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Network
management
 Troubleshooting
 Standardization
 Growth
 Flexibility
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Telepharmacy Technology
Hardware
Polycom Viewstation (VSX7000
Second camera
Document camera
2 mics (mute separately)
PC & printer
2 TV monitors
VPN – for encrypting Rx and video
Telepharmacy Technology –
cont’d
Prescription Processing
Standard Pharmacy Operations Software
Patient Consultation
Polycom ViewStation
Prescription Verification
Polycom Viewstation
HIPAA/Privacy
Virtual Private Network (VPN) – Sonic Firewall
Telepharmacy Technology
Connectivity
Local telephone company
Prescription Processing
Dedicated POTS with 56K modem
Patient Consultation
Symmetric DSL at 512K bandwidth
Lessons learned
Not all pharmacies the same, unique
components
 Customers prefer talking to a “TV”
 Separate prescription processing - consultation
 Polycom units need flexibility (speakers, mics)
 Video works – VPN, firewall, 512K SDSL, 256K
 Different local phone companies
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• Different pricing, solutions
• Internet1 a quality problem beginning at 3pm
Identified Needs
 Standards
(except pharmacy software)
 Video links to all
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Network solutions
 Statewide
Private IP Network
 Connection to Internet2 for out-of-state
NDSU
Killdeer Pharmacy
Radius Authentication Server
Access Device
With integrated VPN
Access Device
With integrated VPN
VPN Accelerator
512X512 DSL
DCN Core Router
DCN Core Router
DCN
T1 Internet Access
ISP Connected to
DCN IP Core
ISP Connected to
DCN IP Core
DSLAM
512X512 DSL
Access Device
With integrated VPN
Beach Pharmacy
NDSU
Killdeer Pharmacy
Radius Authentication Server
Access Device
With integrated VPN
IP Tunnel
IP Tunnels
Pharmacist
Access Device
With integrated VPN
VPN Headend
Student or Instructor
Pharmacy Tech
Access Device
With integrated VPN
Access Device
With integrated VPN
New England Pharmacy
Beach Pharmacy
Pharmacy Tech
Features
Data encryption, authentication & security
provisions – HIPAA
 Secure videoconference between pharmacies
– patient consultation
 Secure data connection with document
camera, database – dispensing
 Management, growth, redundancy, reliability,
QoS (video)
 Internet access
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Future Directions
 Connect
to other states
• Collaboration
• Instruction
• Services
– enabling technology
 Research Universities
 SEGP participants
 Internet2
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High Speed Networks
 Attract
researchers, faculty, students
 Provide increased grant opportunities
 Provide greater access to resources
 Fuel economic development
 Facilitates innovative & progressive
projects
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Thank you
Dr. Charles Peterson
[email protected]
Sandy Sprafka
[email protected]
(701) 231-8688