TECHNOLOGY

Pharmacist shortage boosts telepharmacy

A few years ago, health systems shied away from telepharmacy because their pharma- cists were too busy to take on more work. Now, as the manpower shortage drags on, many of them are rethinking remote dispensing as a way to have one pharmacist serve several outlying clinics.

The impact of the pharmacist shortage caught Telepharmacy Solutions Inc. (TSI) off guard, said Brian Hart, president of the North Billerica, Mass., firm formerly known as ADDS. For the past two years, the dearth of pharmacists has kept potential customers on the sidelines because they were afraid the R.Ph.s they did have were too busy to supervise an automated dispensing unit at an outpatient clinic.

But the light bulb went off after the Community Health Association of Spokane (CHAS) installed a TSI system to network with several clinics. The central pharmacy at the Valley CHAS Medical Clinic serves five remote clinics in a 100-mile radius as part of a $250,000 grant from the Department of Health & Human Services. Serving 13,500 low-income or rural patients who would otherwise have trouble getting medications, CHAS qualified for the federal 340B drug discount program as a safety-net healthcare provider.

"Networking allows them to use one pharmacist to cover five or six locations," said Hart. "It's addressing the labor cost component and making the pharmacist more efficient. Telepharmacy is really becoming a tool to extend that individual pharmacist's reach, and it takes geography off the table. The technology had been there all along, but the evolution of thinking in pharmacy seemed to lag about a year behind. We didn't fully anticipate the impact of the pharmacist shortage."

Dealing with 50 different sets of pharmacy regulations has also slowed telepharmacy. The situation improved a few years ago when the National Association of Boards of Pharmacy issued model telepharmacy regulations. Some state pharmacy boards have adopted the NABP model, but others have lagged behind. Hart said, for example, that New Hampshire funded TSI installations to serve towns without pharmacies, but interpretation of the regs has "slowed the process to a crawl."

While the firm is smaller than anticipated, due in part to the R.Ph. shortage and regulatory barriers, Hart expects to double the current 100 installations by year's end. About half the current sites include a video link so R.Ph.s can offer face-to-face counseling. The biggest customers are federal agencies. The Department of Veterans Affairs, the Department of Defense, Indian Health Service, and Immigration Health Service have all bought into telepharmacy and signed up with TSI.

The VA and DOD have installed units in main medical centers to improve availability of medications at outpatient clinics to cut waiting time at the central pharmacy. And the VA uses the devices for after-hours dispensing, when the pharmacy is closed. The DOD is readying a multicontinent installation. The VA just ordered a dozen additional installations, and the one slated for Guam will be remotely controlled by a pharmacy in Hawaii. A system is being installed at an Indian Health Service clinic on the Navajo Reservation in the Four Corners area of Arizona.

"The federal agencies—especially the VA—like telepharmacy as an enhancement to patient care and satisfaction," said Ed Brezinski, TSI v.p. of government and regulatory affairs. "Sometimes elderly veterans can get kind of crotchety. They don't like waiting around. So if they can get their meds and head home, they feel they're being taken care of. Economically, the system has established itself in the VA as a tool to stay on the Federal Supply Schedule for drug acquisition. We've documented that we're saving the VA, on average, $13 to $15 per script."

Perhaps the biggest boost for TSI came recently, when the giant drug wholesaler AmerisourceBergen bought the company. "We had two issues," said Hart. "One was moving forward financially, and the second was expanding our reach and integrating more with the total drug delivery system. AmerisourceBergen wanted technology that would not compete with its customers but would assist them. They also have federal supply contracts and a large share of the DOD contract, and they're the preferred provider for the government's 340B program. AmerisourceBergen will open more doors for us."

Carol Ukens

Carol Ukens. Pharmacist shortage boosts telepharmacy.

Drug Topics

2002;11:53.