- In rural communities across the country, it’s often more difficult to find a pharmacist than it is to find a doctor. Now healthcare providers are using telemedicine platforms to create telepharmacy networks and bring the pharmacist into the clinical conversation.
At Dartmouth-Hitchcock Medical Center in Lebanon, N.H., Sarah Pletcher, MD, oversees the Center for Telehealth, which offers (among other things) telepharmacy services to six smaller hospitals around New England and has another dozen in the pipeline. The founder and director of the four-year-old center, she says the new service is invaluable to providers who need clinical decision support at a moment’s notice.
“We’re extending the pharmacist into the clinical setting,” she says. “There’s a lot that a pharmacist can offer” clinicians at the point of care, such as drug dosing and interaction information, medication management guidelines, even information on alternatives or generics.
Unlike a telestroke platform, in which the outcomes and benefits are clear, Pletcher says telepharmacy services are still being defined, and she’s finding that each hospital uses them differently. In some cases, a hospital will assign its on-site pharmacists to new tasks, such as working with quality control or clinical care management teams or even IT implementations.
“We’ve begun to really appreciate the power of integration,” she says, adding that the telepharmacy network could, in time, be extended to other settings, like clinics, senior nursing facilities and medical offices. “Our goal really is to effect a virtual health system” that can draw on the best resources – no matter where they’re located – to improve the clinical outcome.
At CGH Medical Center in Sterling, Ill., a 1,500-person town nestled in the Rock River Valley, Pharmacy Director Tim Dunphy saw an opportunity to expand his services far beyond the 100-bed hospital. In the shadow of larger networks like HCA, Caremark and Cardinal Health, he saw a lot of small, community-minded hospitals who couldn’t afford their own full-time pharmacies but wanted to keep those services close to home.
“Everyone wants to stay somewhat independent without getting gobbled up,” he says.
“I thought I’d just do it myself,” says Dunphy, who set up a telepharmacy service some three years ago with PipelineRx, a San Francisco-based telepharmacy provider who also set up the Dartmouth-Hitchcock platform. “Small hospitals can be somewhat provincial … but I think they recognized there was a service here that we could provide that would keep things in the community.”
Dunphy says he and his five-person staff “went through some growing pains” building the telepharmacy platform – “it wasn’t like we could just hit an ‘Easy’ button and everything worked” – but now are seeing some 5,500 transactions a month. In addition, the platform has allowed CGH Medical Center to send three nurses out into the community to check on post-discharge patients.
“Once you’ve got that victory under your belt, you start seeing what else you can do, and then once thing just leads to another,” he says. “And to think, it all started with us wanting to get some orders verified.”
PipelineRx CEO Brian Roberts says telepharmacy programs comprise about 10 percent of the estimated $25 billion telehealth industry in the U.S., and could very easily grow as more and more health systems get used to the technology and find new ways to use it.
“It’s an inexpensive solution to a growing need,” he says. “Skilled pharmacists can create all sorts of interventions and avoid a lot of clinical errors” – including reducing the estimated 40 percent of discharged patients who don’t fill their prescriptions or have inaccurate prescriptions because of an error in their discharge plans.
Roberts says more and more health systems see a telepharmacy service as a revenue driver, extending the hospital’s reach out to specialty clinics, nursing homes, urgent care centers, schools, prisons - even retail and community pharmacies that could use on online or video link to the local healthcare provider for expert consults.
“We’re allowing them to make the best use of their resources,” he says.