The North Dakota Telepharmacy Project
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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.

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The North Dakota Telepharmacy Project Restoring and Retaining Pharmacy Services in Rural Communities

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The north dakota telepharmacy project restoring and retaining pharmacy services in rural communities

The North Dakota Telepharmacy ProjectRestoring 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

North Dakota Demographics2000 Census Highlights

  • 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

Pharmacy Services in ND

  • 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

North Dakota Rural Health Care Crisis:Community Pharmacy Closings

  • 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

Exploring Solutions:Telepharmacy Rules

  • 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

Telepharmacy Grant Awarded NDSU College of Pharmacy

  • Congressionally mandated federal grant via the support of Senator Byron Dorgan

  • Office for Advancement of TeleHealth, Health Resources and Services Administration of HHS

  • First Initiated: September 1, 2002

  • $1,671,621 federal support to date


Goals of telepharmacy grant

Goals of Telepharmacy Grant:

  • RESTORATION - restore pharmacy services in rural communities which have lost their services

  • RETENTION - retain pharmacy services in rural communities which are at risk of losing their services


Telepharmacy project partners

Telepharmacy Project Partners

  • NDSU College of Pharmacy

  • North Dakota State Board of Pharmacy

  • ND State Pharmaceutical Association

  • Licensed rural community pharmacies

  • Targeted rural communities


Telepharmacy grant budget

Telepharmacy Grant Budget

  • 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

Pharmacy Technician Responsibilities: Remote Telepharmacy Site

  • 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

Technician Training Requirements: Telepharmacy Sites

  • 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

Pharmacist Responsibilities

  • Final check of technician Rx preparation

  • Dispenses drug to the patient

  • Drug utilization review

  • Patient education counseling


Demographics remote telepharmacy sites

Demographics:Remote Telepharmacy Sites


Demographics remote telepharmacy sites1

Demographics:Remote Telepharmacy Sites


Benefits to north dakota with the telepharmacy program

Benefits to North Dakota with the Telepharmacy Program

  • 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

Economic Impact of Telepharmacy

  • 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

Economic Development Add’l Benefits of Telepharmacy

  • 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

Pharmacy Student Involvement

  • 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

Student Activities

  • 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

Future Goals of Telepharmacy in North Dakota

  • 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

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

From the technical side …. Project parameters

  • Independent, privately owned businesses

  • Keep costs down

  • Keep prescription processing separate from consultation


The north dakota telepharmacy project restoring and retaining pharmacy services in rural communities

Independent Pharmacy Clusters


Issues to address

HIPAA

Authentication

Secure connections

Reliability

Internet1

Costs

Network management

Troubleshooting

Standardization

Growth

Flexibility

Issues to Address


Telepharmacy technology hardware

Telepharmacy TechnologyHardware

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

Telepharmacy Technology – cont’d

Prescription Processing

Standard Pharmacy Operations Software

Patient Consultation

Polycom ViewStation

Prescription Verification

PolycomViewstation

HIPAA/Privacy

Virtual Private Network (VPN) – Sonic Firewall


Telepharmacy technology connectivity

Telepharmacy TechnologyConnectivity

Local telephone company

Prescription Processing

Dedicated POTS with 56K modem

Patient Consultation

Symmetric DSL at 512K bandwidth


Lessons learned

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

    • Different pricing, solutions

    • Internet1 a quality problem beginning at 3pm


Identified needs

Identified Needs

  • Standards (except pharmacy software)

  • Video links to all


Network solutions

Network solutions

  • Statewide Private IP Network

  • Connection to Internet2 for out-of-state


The north dakota telepharmacy project restoring and retaining pharmacy services in rural communities

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

DCN IP Core

ISP Connected to

DCN IP Core

DSLAM

Public

Internet

512X512 DSL

Access Device

With integrated VPN

Beach Pharmacy


The north dakota telepharmacy project restoring and retaining pharmacy services in rural communities

NDSU

Killdeer Pharmacy

Radius Authentication Server

Access Device

With integrated VPN

IP Tunnel

IP Tunnels

Pharmacist

Access Device

With integrated VPN

VPNHeadend

Student or Instructor

DCN IP Core

IP Tunnel

IP Tunnel

Pharmacy Tech

Access Device

With integrated VPN

Access Device

With integrated VPN

New England Pharmacy

Beach Pharmacy

Pharmacy Tech


Features

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


Future directions

Future Directions

  • Connect to other states

    • Collaboration

    • Instruction

    • Services

  • Internet2 – enabling technology

  • Research Universities

  • SEGP participants


High speed networks

High Speed Networks

  • Attract researchers, faculty, students

  • Provide increased grant opportunities

  • Provide greater access to resources

  • Fuel economic development

  • Facilitates innovative & progressive projects


Thank you

Thank you

Dr. Charles Peterson

[email protected]

Sandy Sprafka

[email protected]

(701) 231-8688


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