Remote clinic hooks up with interactive pharmacy
Pharmacist counsels patients via live video
Many of the rural clinics of the University of Utah Hospitals & Clinics (UUHC) in Salt Lake City have too few patients to support a full-time pharmacist. Often, in isolated locations with no local pharmacies, patients at these clinics had to drive 50 miles or more to get a prescription filled.
To UUHC, telemedicine offered a way to solve this problem. The university put together a pilot program with Park City-based Summit Health Center, an outpatient clinic located about 25 miles from Salt Lake City, and Massachusetts-based Automated Drug Dispensing Systems Inc. (ADDS). The system lets UUHC hospital pharmacists receive and dispense prescriptions to remote clinics via networked computers, and for the first time counsel patients across an interactive, computer-controlled video monitor.
The Park City clinic is the test site. Here pharmacists run the telepharmacy program, test patient/pharmacist communication links, and fix any problems that may arise before the program is implemented in UUHC’s more rural clinics.
"Our clinic was chosen for the test run because it was easier to troubleshoot," says Bob Bennett, RN, MS, clinic manager at the University of Utah Summit Health Center. "Our main motivation was research. We didn’t want to get it set up in our rural sites until we learned on it first. We’re not very far from Salt Lake City, so it doesn’t take much for their [pharmacist manager] to run back and forth between hospitals to work out any glitches if we need to," he adds.
The telepharmacy pilot program was set up in Utah Summit’s former medication samples room. (The official program started Aug. 1.) The room, although relatively small, is large enough to house the equipment needed to run the ADDS system: a drug dispensing unit, fax machine, computer system and video monitor, as well as the doctor and patient.
Setting the telepharmacy scene
Despite the system’s complex telecommunication network that links the two facilities, Bennett says the program works quite simply. The patient and doctor at the rural site enter the telepharmacy room where the doctor faxes the prescription to the pharmacist at the parent hospital. The pharmacist enters the data into the computer, which triggers the automated dispensing machine at the off-site clinic to release the barcoded medication, much like a vending machine drops an item. A nurse or technician then scans the bottle to double check the medication type and dosage, while the pharmacist counsels the patient via a video link.
"The interaction between the patient and pharmacist is very important," Bennett says. "They can talk and see one another in real time and answer any questions just like a typical pharmacy would. The system has a program that cross-references other drugs with the prescribed drug to guard against interactions. There’s also a hard copy [of instructions] that patients take with them," he adds.
How have the doctors and patients reacted to the program? For the most part, responses have been positive, says Judy Schneider, PharmD, pharmacy manager at the University of Utah.
"We went to the Utah State Board of Pharmacy about a year ago and told them this was something we were looking at doing. At first, they weren’t too keen on it because the state of Utah does not typically allow a nonpharmacist to affix a medication label, which is how the system works," she explains. "But they were willing to work with us as long as it is used in rural facilities where patients don’t have access to other pharmacies."
Patients, although somewhat intimidated by the technology, have also reacted favorably, Bennett says. "The patients we used for demos when we first [began testing the system] seemed a little leery, mainly because patients can see themselves on a small section of the monitor when they are speaking with the pharmacist. But they were also very intrigued. People tend to fear technology a bit, but when this is [offered] to patients in more rural areas, I think they will really appreciate the program."
To ensure patient satisfaction, the University of Utah pharmacists plan to administer a series of surveys, one on the initial visit, followed by phone questionnaires.
"This is a very important step because it’s our chance to see how comfortable the patients are with the program and make sure they are not overwhelmed by the technology," says Schneider. "The idea of this [program] is to offer a great service to the patient, so we want to make sure what we’re doing is not backfiring. During the phone surveys, we can assess their medical understanding and answer any questions they may not have thought to ask at the time. We can also see what areas need to be worked on."
Although improving customer service is key, the telepharmacy technique also makes the job of both physician and pharmacist more efficient, according to Brian Hart, president of ADDS.
"For a typical pharmacy, it takes 150 prescriptions per day for it to break even financially," Hart says. "But because the pharmacist is only accessed when he’s needed and there’s no overhead of a regular pharmacy, it only takes about 25 prescriptions to break even using [telepharmacy]." (See graph, p. 117.)
In addition to the financial gains received by eliminating the need for a rural clinic pharmacist and reducing prescription costs, Bennett says the system also helps ensure that medications are going to be filled. "If patients in rural clinics have to travel far to get prescriptions filled, it’s likely that the medication [will not be dispensed]," he explains. "If they can get their prescriptions right after they see the doctor, it’s much more convenient."
But with any new technology comes a set of new problems and disadvantages. By using mock scenarios, the University of Utah was able to spot any malfunctions and prime the improvement process before the clinic goes live with the telepharmacy program.
"The [medication dispensing] unit we are using looks and loads like a pop machine on the inside," Schneider says. "Some of the bottles that are loaded into the machine fit too snugly and wouldn’t drop out of the machine. We’re fortunate that we can work on things like this and get them working perfectly before they go into other [clinics]," she adds.
How are small rural facilities expected to afford such a luxury? According to Hart, the costs are relatively minimal.
"Right now, we’re only working with [facilities] on a profit-share basis. That means we set them up with all the hardware and software, and the only thing they have to buy is the prepackaged meds that they buy off of their GPO contracts. Then we split the gross profits," he says. "We’re also looking at setting up a lease program, but we haven’t put together any figures for that yet."
Despite the equipment’s convenient applications and apparent accessibility, at some point, some patients will still have to rely on outside pharmacies, particularly because the machines cannot store every kind of medication. For example, Utah Summit’s model, called the RCD1, holds only 40 of the most commonly prescribed medications. Larger models can house double to triple that amount but still cannot dispense certain kinds of drugs.
"Most patients will be able to get what they need, but there will be some that can’t," Bennett notes. "For example, some medications need to be refrigerated, and the unit isn’t capable of doing that."
So where and when will the telepharmacy program surface next? Although no dates have been officially set, the most likely location is a rural clinic in Wendover, NV, says Schneider. The small University affiliate is located on the Utah border about 120 miles from Salt Lake City, separated only by desert.
"Wendover’s population is only about 6,000, and it’s pretty much out in the middle of nowhere," she says. "There aren’t any pharmacies close by, so this system would work very well there. It looks like that will be our next location once we get things squared away [in Utah]. We’re just not sure when that will be."
But UUHC sites are not the only facilities interested in joining the program. A homeless shelter near the University also hopes to take advantage of the program.
"The homeless shelter has a clinic, but no pharmacy, which makes it difficult for the people to get their medication," says Schneider. "We’re trying to co-fund for the University of Utah College of Pharmacy students to work at the shelter. There are so many possible applications. Our goal is not to compete with other community facilities, but to offer the [program] where the patients can benefit the most. And so far people have really been willing to work together to make that happen."
[For more information about the teleradiology program, contact: Nethla Shires, Trinity Hospital, Erin, TN. Telephone: (615) 289-4211. Or InTelemed, One Grand Park, 777 N.W. Grand Blvd., Suite 145, Oklahoma City, OK 73118. Telephone: (405) 858-5148.
For more information on the interactive telepharmacy program, contact: Judy Schneider, University of Utah Hospital, 50 N. Medical Dr., Room A050, Salt Lake City, Utah 84132. Telephone: (801) 647-5740. Bob Bennett, University of Utah Summit Health Center, 1750 W. Sun Peak Dr., Park City, Utah 84098. Telephone: (801) 647-5740. Brian Hart, ADDS Inc., Forest Ridge Research Park, 85 Rangeway Road, N. Billerica, MA 01862. Telephone: (508) 670-0746.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content