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Telepharmacy
I had the opportunity to speak at a meeting of the American Telemedicine Association meeting in San Jose last week. The speech wasn't until 4:15 PM so I had some time to look through the materials and run around the vendor exhibition. I was struck by a few things:

1) There was a lot of vendor/IT/user collaboration. Indeed, the board of directors for the organization had a number of people from each of those communitites on it and was proudly published on a wall-high poster in the meeting foyer.

2) There were a lot of technology vendors selling infrastructure specifically for telemedicine as well as a lot of focused software solutions on the kinds of things that telenursing, telemedicine, and teleradiology had identified as useful and appropriate. What they were selling said a lot about both the amount of experience people had with these aspects of telemedicine, and the degree of involvement from the vendor community.

3) There was one booth for telepharmacy, and it was for a company that sold telepharmacy services in the form of everything but remote supervision of actual distribution. The kinds of practice support for dermatology, or mental health, or radiology, or even laboratory services was completely absent in regards to pharmacy.

4) My presentation was on the state of pharmacy law and technology requirements for telepharmacy. I was presenting along with two folks from Eastern Washington State who have pushed for telepharmacy support in a state that has no enabling law... yet. I was fascinated to learn that their implicit definition of telepharmacy did not include any kind of support for actual medication dispensing other than requiring that the supported pharmacy have automated dispensing cabinets and the ability for them to log into the pharmacy system for that hospital.
 
Don't get me wrong; what they have done fullfills a critical need in critical access hospitals both in terms of regulatory compliance and in terms of providing medication order review and clinical pharmacy consultative services. And the journey that got them there took a lot of effort, a lot of commitment, and some risk by the pharmacists who actually had to put the program together as a business on which they staked both their livelihoods and reputations. They are doing what they can in a context that enables very little.

But nurses are still mixing IV's...

What I came away with was the notion that we have done very little as an organization to describe what telepharmacy really ought to look like. While it is easy to poke fun at some of what has been placed into law (e.g., what could be more meaningless than legislating that everybody has to run on the same CPU?), what guidance have we given to NABP and others about what kinds of infrastructure that should be in place? What kinds of controls and registration/licensure should exist?

There are currently about 14 different states (including Washington, DC!) that have laws that enable some kind of telepharmacy activity. The range of requirements is quite broad. I have spoken to a couple of Boards of Pharmacy who have acknowledged that they really do have critical access sites where they should address this, but seem reluctant to do so. There appears to be concern about setting up pharmacist call centers outside of the country and loss of pharmacist jobs.

It seems to me that the same issues that we are confronting in PPMI are the issues that may be standing in the way of getting advanced pharmacy services to patients who have chosen to live on our frontiers (amazing to think we still have frontiers, but we do).

So how could we go about building support for those patients with severe access problems (e.g. the nearest hospital is more than 100 miles away) into our new, more advanced pharmacy practice model?

Something to think about... what's your opinion?

Created By: Dennis Tribble On: Sun, May 06, 2012 06:10 PM

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Eric Kastango May 08, 2012 3:17 pm
I believe one of the things that stop us is our fear of obsolescing ourselves. As a pharmacist and a manager, prior to getting laid off twice, I worked to obsolete myself by advancing my practice and giving other responsibilities in all of my jobs. It was scary but I landed more or less unscathed but smarter and more determined each time. I have come to learn that we need to control our own destiny and define the future so it will look like something we want it to be, OR someone else will do it for us (and is probably working on it now!) and it will not be a happy place to be. We have a unique to serve patients in ways that were not possible 10 years ago but it requires courage and taking the path least taken or we have to start bushwhacking to get to where we want to be, which may be the unknown.

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