The North Dakota Telepharmacy The North Dakota Telepharmacy ProjectProject

Restoring and Retaining Pharmacy Services Restoring and Retaining Pharmacy Services in Rural Communitiesin Rural Communities

Charles D. Peterson, Pharm.D.Charles D. Peterson, Pharm.D.

Dean & ProfessorDean & Professor

College of PharmacyCollege of Pharmacy

Sandy Sprafka, Information Tech ServicesSandy Sprafka, Information Tech Services

North Dakota State UniversityNorth Dakota State University

Fargo, North DakotaFargo, North Dakota

North Dakota Rural Health Care Crisis:North Dakota Rural Health Care Crisis:Community Pharmacy ClosingsCommunity Pharmacy Closings

26 rural community pharmacy closings26 rural community pharmacy closings 12 additional pharmacies at risk of 12 additional pharmacies at risk of

closingclosing pharmacist retirements - no pharmacist retirements - no

replacementreplacement national pharmacist shortagenational pharmacist shortage negative impact on rural healthnegative impact on rural health

Telepharmacy Grant Awarded Telepharmacy Grant Awarded NDSU College of PharmacyNDSU College of Pharmacy

Congressionally mandated federal grant via the Congressionally mandated federal grant via the assistance and support of Senator Byron Dorganassistance and support of Senator Byron Dorgan

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

First Initiated: September 1, 2002 First Initiated: September 1, 2002

$1,671,621 federal support to date$1,671,621 federal support to date

Goals of Telepharmacy Grant:Goals of Telepharmacy Grant:

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

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

Pharmacy Technician Responsibilities: Pharmacy Technician Responsibilities: Remote Telepharmacy SiteRemote Telepharmacy Site

• Maintains drug inventory at remote siteMaintains drug inventory at remote site• Processes all prescriptions orders including Processes all prescriptions orders including

controlled substancescontrolled substances• Computer order entry, filling, billing, labelingComputer order entry, filling, billing, labeling• Takes original prescription orders by phoneTakes original prescription orders by phone• Prepares prescription for dispensing by Prepares prescription for dispensing by

pharmacistpharmacist• Connects patient to the pharmacist for private Connects patient to the pharmacist for private

consultation via audio and video linkconsultation via audio and video link

Pharmacist ResponsibilitiesPharmacist Responsibilities

• Final check of technician Rx preparationFinal check of technician Rx preparation• Dispenses drug to the patientDispenses drug to the patient• Drug utilization reviewDrug utilization review• Patient education counselingPatient education counseling

Telepharmacy Sites March 2004

Benefits to North Dakota with Benefits to North Dakota with the Telepharmacy Programthe Telepharmacy Program

Improved access to health care for rural citizensImproved access to health care for rural citizens Rural economic developmentRural economic development Improved quality of care/pharmacist consultsImproved quality of care/pharmacist consults Increased patient & pharmacist satisfactionIncreased patient & pharmacist satisfaction Increase financial viability of rural pharmaciesIncrease financial viability of rural pharmacies Increased educational opportunities for studentsIncreased educational opportunities for students Increased retention of pharmacy graduatesIncreased retention of pharmacy graduates

Economic Impact of TelepharmacyEconomic Impact of Telepharmacy

• Has added a $500,000 per year business to Has added a $500,000 per year business to the rural communitythe rural community

• Thus far, has added an estimated total of Thus far, has added an estimated total of $4.5 million annually to the North Dakota rural $4.5 million annually to the North Dakota rural economyeconomy

• Has added an estimated 25-30 new jobs to Has added an estimated 25-30 new jobs to the North Dakota rural marketplacethe North Dakota rural marketplace

• Has added 40-50% increase in prescription Has added 40-50% increase in prescription sales to combined pharmacy operationsales to combined pharmacy operation

Future Goals of Future Goals of Telepharmacy in North DakotaTelepharmacy in North Dakota

5 - 10 new community sites each year5 - 10 new community sites each year 50 telepharmacy sites in five years50 telepharmacy sites in five years develop a model for serving rural hospitalsdevelop a model for serving rural hospitals assist other states in implementing assist other states in implementing

telepharmacy services in rural areas telepharmacy services in rural areas establish a state-wide data & video networkestablish a state-wide data & video network establish equipment standardsestablish equipment standards

From the technical side …. From the technical side …. Project parametersProject parameters

Independent, privately owned Independent, privately owned businessesbusinesses

Keep costs downKeep costs down Keep prescription processing separate Keep prescription processing separate

from consultationfrom consultation

ConcernsConcerns

HIPAAHIPAA AuthenticationAuthentication Secure connectionsSecure connections Reliability Reliability Internet1Internet1

Network Network managementmanagement

TroubleshootingTroubleshooting StandardizationStandardization Growth Growth FlexibilityFlexibility

Multiple Hardware SolutionsMultiple Hardware SolutionsYikes!!Yikes!!

Prescription processing:Prescription processing:PC, Printer, Logitech Quickcam or Live Imaging w Audio, PC, Printer, Logitech Quickcam or Live Imaging w Audio,

NetMeeting, pharmacy softwareNetMeeting, pharmacy software

ConsultationConsultation: Polycom, Logitech: Polycom, Logitech

NetworkNetwork: VPN encrypt Rx & video : VPN encrypt Rx & video

Firewall: (Sonicwall Tele3, Cisco PIX, D-Link, None (ATM Firewall: (Sonicwall Tele3, Cisco PIX, D-Link, None (ATM switch)switch)

Data: 56K frame relay or 56K modem (POTS)Data: 56K frame relay or 56K modem (POTS) Video: 512K SDSLVideo: 512K SDSL

Independent Pharmacy Clusters

Lessons learnedLessons learned Not all pharmacies the same, unique componentsNot all pharmacies the same, unique components Customers prefer talking to a “TV”Customers prefer talking to a “TV” Separate prescription processing - consultationSeparate prescription processing - consultation Standards needed (except pharmacy software)Standards needed (except pharmacy software) Polycom units need flexibility (speakers, mics)Polycom units need flexibility (speakers, mics) Video works – VPN, firewall, 512K SDSL, 256KVideo works – VPN, firewall, 512K SDSL, 256K Different local phone companiesDifferent local phone companies

• Different pricing, solutionsDifferent pricing, solutions• I1 & quality problem beginning at 3pmI1 & quality problem beginning at 3pm

Need video links to allNeed video links to all

Possible solutionPossible solution

Statewide Private IP NetworkStatewide Private IP Network

DCNT1 Internet Access

DCN Core RouterDCN Core Router

VPN Accelerator

Killdeer PharmacyNDSU

Beach Pharmacy

Access Device With integrated VPN

ISP Connected to DCN IP Core

Access Device With integrated VPN

Access Device With integrated VPN

DSLAM

ISP Connected to DCN IP Core

512X512 DSL

512X512 DSL

Radius Authentication Server

Radius Authentication Server

VPN Headend

Killdeer PharmacyNDSU

Beach Pharmacy

IP Tunnel

Access Device With integrated VPN

Access Device With integrated VPN

Access Device With integrated VPN

IP Tunnel

New England Pharmacy

Access Device With integrated VPN

IP Tunnels

IP T

unnel

Student or Instructor

Pharmacy Tech

Pharmacy Tech

Pharmacist

FeaturesFeatures

Data encryption, authentication & security Data encryption, authentication & security provisions – HIPAAprovisions – HIPAA

Secure videoconference between pharmacies Secure videoconference between pharmacies – patient consultation– patient consultation

Secure data connection with document Secure data connection with document camera, database – dispensingcamera, database – dispensing

Management, growth, redundancy, reliability, Management, growth, redundancy, reliability, QoS (video)QoS (video)

Internet accessInternet access

Thank youThank you

Dr. Charles PetersonDr. Charles Peterson

charles.peterson@ndsu.nodak.educharles.peterson@ndsu.nodak.edu

Sandy SprafkaSandy Sprafka

sandy.sprafka@ndsu.nodak.edusandy.sprafka@ndsu.nodak.edu

(701) 231-8688(701) 231-8688