Charles D. Peterson, Pharm.D. Dean & Professor College of Pharmacy

1. 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

2. 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

3. Telepharmacy Grant Awarded NDSU College of Pharmacy • Congressionally mandated federal grant via the assistance and 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

4. 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

5. 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

6. Pharmacist Responsibilities • Final check of technician Rx preparation • Dispenses drug to the patient • Drug utilization review • Patient education counseling

14. Telepharmacy Sites March 2004

15. Benefits to North Dakota with the Telepharmacy Program • Improved access to health care for rural citizens • Rural economic development • Improved quality of care/pharmacist consults • Increased patient & pharmacist satisfaction • Increase financial viability of rural pharmacies • Increased educational opportunities for students • Increased retention of pharmacy graduates

16. Economic Impact of Telepharmacy • Has added a $500,000 per year business to the rural community • Thus far, has added an estimated total of $4.5 million annually to the North Dakota rural economy • Has added an estimated 25-30 new jobs to the North Dakota rural marketplace • Has added 40-50% increase in prescription sales to combined pharmacy operation

17. 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

18. From the technical side …. Project parameters • Independent, privately owned businesses • Keep costs down • Keep prescription processing separate from consultation

19. HIPAA Authentication Secure connections Reliability Internet1 Network management Troubleshooting Standardization Growth Flexibility Concerns

20. Multiple Hardware SolutionsYikes!! Prescription processing: PC, Printer, Logitech Quickcam or Live Imaging w Audio, NetMeeting, pharmacy software Consultation: Polycom, Logitech Network: VPN encrypt Rx & video • Firewall: (Sonicwall Tele3, Cisco PIX, D-Link, None (ATM switch) • Data: 56K frame relay or 56K modem (POTS) • Video: 512K SDSL

21. Independent Pharmacy Clusters

23. Lessons learned • Not all pharmacies the same, unique components • Customers prefer talking to a “TV” • Separate prescription processing - consultation • Standards needed (except pharmacy software) • Polycom units need flexibility (speakers, mics) • Video works – VPN, firewall, 512K SDSL, 256K • Different local phone companies • Different pricing, solutions • I1 & quality problem beginning at 3pm • Need video links to all

24. Possible solution • Statewide Private IP Network

25. 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

26. 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

27. 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

28. Thank you Dr. Charles Peterson charles.peterson@ndsu.nodak.edu Sandy Sprafka sandy.sprafka@ndsu.nodak.edu (701) 231-8688