Telepharmacy Bridges the Gap Between Access and Adherence

NOVEMBER 01, 2008
Eileen Koutnik-Fotopoulos
Staff Writer

Registered Pharmacist Steve Singer is using technology on a large scale in the Pacific Northwest. Bellegrove Pharmacy (Bellevue, Washington) operates 3 telepharmacy sites with plans for additional sites throughout the state.

The locations use Telepharmacy Solutions from the AmerisourceBergen Technology Group. Telepharmacy Solutions' Automating Drug Dispensing Systems (ADDS) integrate remote or local pharmacist-controlled dispensing system cabinetry and software, pharmacy software, and televideo technology into one seamless system. As a cost-effective alternative, telepharmacy can be used in local and rural clinics, nursing homes, assisted living centers, Department of Defense clinics, and Veterans Affairs?community-based outpatient clinics.

Bellegrove Pharmacy opened its first telepharmacy at Stillaguamish Tribe Clinic at Island Crossings Center in Arlington in March 2006. Two locations opened in 2008 at Royal City Clinic (January) and Mattawa Community Clinic in (May).

Before Bellegrove Pharmacy could open a telepharmacy site, it needed approval from the Washington State Board of Pharmacy. Singer said the board has no formal rules for retail telepharmacies. "Obtaining approval requires a presentation to the board, detailing the rational for allowing a telepharmacy, policies and procedures, equipment review, and an on-site inspection of the remote site and the central pharmacy."

The approval process for Stillaguamish Tribe Clinic was time consuming as the board had never approved a retail telepharmacy. The pharmacy spent more than 6 months working with the board and board consultants preparing for the presentation and inspection. Once approval was received, it was limited to 1 telepharmacy for 1 year, with the requirement that the pharmacy report back at the end of 1 year to update the board on the progress and changes in procedures based upon the experience.

"Telepharmacies allow Bellegrove to provide pharmacist and pharmacy services in communities that otherwise do not have convenient access to a pharmacist. The system allows us to provide these services at a cost that cannot be duplicated with a pharmacy and pharmacist in the community."

The pharmacy chose Telepharmacy Solutions after reviewing other systems and conducting site visits. "We preferred the system because of the enhanced security features that allowed, in our opinion, greater accuracy," said Singer.

"Telepharmacy brings cognitive pharmacy care to underserved areas," said Scott Tague, director of sales for Telepharmacy Solutions. "Because the pharmacist is controlling the system, it allows for greater patient compliance, which has an immediate benefit for the patient. Furthermore, it allows a pharmacy to grow the business without a ?brick and mortar' pharmacy."

Telepharmacy Solutions' ADDS is available in 3 offerings, which are all narcotics secure. The ADDS 2.0 stores and dispenses from 27 to 36 nonuniformly packaged unit-of-use medications, and holds between 10 and 20 units of each individual medication. The cabinet is ideal for dispensing pediatric suspensions, oral contraceptives, inhalers, small intravenous bags, and other nonuniformly packaged medications.

The ADDS 3.0 stores and dispenses 60 different medications, and holds 18 bottles per medication for a total unit capacity of 1080 bottles. The cabinet dispenses oral solids, which are repackaged in standard 75 mL plastic vials, and stacked in 60 vertical columns within the ADDS cabinet. This system can sit on top of the ADDS 2.0 to minimize the need for additional floor space.

The newest offering is the ADDS 8.0. Under pharmacist control, this system dispenses single units of up to 80 medications in nonuniform, unit-of-use packaging. The system houses 8 medication trays, each with up to 10 rows of spiral helixes and configurable to store 5 to 30 units per medication. System features include password-protected user control, triple-check barcode scanning, and point of care prescription dispensing.

The medication the systems can dispense is dependent on what the clinic is dispensing. "Pharmacists can meet with the doctors to discuss formulary. This technology offers the opportunity for the pharmacist and doctor to collaborate, and it has been working very well," said Tague.

ADDS technology ensures dispensing and safety through the prescription review process by which medications are triple verified by the system. Each column in the ADDS cabinet is designated to a specific bar code. All medications have a bar-coded label that matches the designated column number. Medications are initially scanned when loaded into the dispensing cabinet, and scanned a second and third time when dispensed from the cabinet and when the patient-specific label is printed. The loading and dispensing processes are fully under pharmacist control. The patient and medication label will not be printed until the proper medication is dispensed and is verified by scanning.

Singer said the system's ease of use and interoperability also are important features. Training the technicians and pharmacist took only about 2 weeks. "The technician managing the remote site (depending on prior experience) dedicated a week at the home site to learn how we process prescriptions. The technician spent another week at an established telepharmacy to work with the remote site technician."

The pharmacist did not require a lot of training to adapt to the system "because the check-off and verification processes are very similar to what would be done in a normal retail setting. For our telepharmacist, it took about 2 weeks to get accustomed to the video camera and talking to patients remotely."

The telepharmacy system can function as a stand-alone system, but in Singer's case and the vast majority of sites, a pharmacy's existing software can interface with the system.

Staff feedback has been positive, said Singer. One pharmacist said, "Telepharmacy is of great benefit to the local community. It provides medicine in real time to the locals." A technician shared, "The pharmacists at the home site appreciate the accuracy and confidentiality of the telepharmacies. The bar code on the stock bottles against the patient label ensures accuracy. The headset allows us to counsel our patients without the fear of violating a patient's privacy if another party accidentally overhears the conversation."

The future of telepharmacy is bright, according to Tague. He feels it is going to expand throughout the United States over the next several years as more clinicians and regulating bodies embrace the technology. "We have systems across the United States and not just a concentration of sites. Every state has its challenges with geography and access."