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Expand your market through the use of technology

The Big Idea:
You may be able to expand your business at relatively low cost by setting up a small dispensing site staffed by a single technician.

Since telepharmacy is a relatively new concept, let’s start with a definition. The experts at North Dakota State University explain it as follows: “Through the use of state-of-the-art telecommunications technology, pharmacists are able to provide pharmaceutical care to patients at a distance. Telepharmacy expands access to quality healthcare to communities nationwide, primarily in rural, medically underserved areas.

According to Roby Miller, CEO of TelePharm, an Iowa-based telehealth company working with pharmacy owners and communities to provide telepharmacy solutions, almost every state now allows telepharmacy in hospitals and 27 states now permit retail telepharmacy.

In his home state of Iowa, Miller noticed that 46 pharmacies closed between 2010 and 2012, leaving more than 220,000 patients without access to critical services. These residents, many of them elderly, were forced to travel long distances for the healthcare services that were previously available locally. This prompted Miller to create TelePharm in 2012 in an effort to provide access to a pharmacist in underserved areas.

Today, Miller is encouraging pharmacy owners to “think about reinventing your business through telepharmacy.” While the chain pharmacies are adding clinics in their stores, an independent can take a different route by “putting yourself virtually in a clinic.” For example, a pharmacist may be able to counsel a patient in an exam room through a tablet computer.

One Independent’s Path to Telepharmacy

With only about 1,400 residents, Elroy, Wisconsin, appeared unable to support a pharmacy when the one in town closed about three years ago. Since October 2014, however, residents have been able to fill prescriptions and consult with a pharmacist without leaving town, thanks to a telepharmacy dispensing location established by Phillips Health Mart Pharmacy.

“We were looking for a way to increase our prescription volume in a market that is challenging,” pharmacy owner Wayne MacArdy explained.

The Elroy location, staffed by a pharmacy technician from 8 a.m. to 4:30 p.m. weekdays, keeps a full inventory tailored to the prescribing patterns of local providers. The technician fills about 30 prescriptions per day from this inventory, with another 10 or so prescriptions for medications such as controlled substances delivered from the main pharmacy about 12 miles away in Mauston.

A series of cameras and a high-speed computer connection allow a pharmacist from Mauston to monitor and communicate with the technician, check prescriptions, and counsel patients remotely through videoconferencing.

Telepharmacy Growing

Phillips Health Mart Pharmacy became the second independent pharmacy in Wisconsin dispensing prescriptions by telepharmacy. While telepharmacy first gained ground as a way to provide coverage to rural hospitals, the trend is growing as a solution for underserved communities.

Telepharmacy “has been proving its worth and value,” said Charles Peterson, director of the North Dakota Telepharmacy Project, who first wrote a federal grant application to implement a statewide telepharmacy program in 2002. Today, 53 retail pharmacies are involved in the North Dakota project, and studies have shown telepharmacy locations to have error rates below the national average.1,2

The emergence of the telepharmacy model in North Dakota came from pharmacists in rural communities being ready to retire but not finding buyers for their businesses.

With 64 being the average age of a pharmacist, telepharmacy offers a new opportunity to reinvent their businesses. “Walgreens and CVS are not always the answer to your exit plan,” said Miller.

Improving Operational Efficiencies for Multiple Stores

Rural communities certainly are not the only scenario where telepharmacy can offer a solution. Allowing remote pharmacists to check prescriptions can improve workflow and allow more time for patient counseling. For example, TelePharm works with a pharmacy with six urban stores, for which the prescription volume for each might require 1.5 pharmacists. With telepharmacy, “We can load balance these prescriptions between all the stores,” Miller explained.

Pharmacies also can create a hybrid model with a pharmacist in a location certain days and available remotely on other days. “Telepharmacy is really a great, affordable tool that is expanding pharmacy business,” Peterson said. It allows a retail pharmacy owner to:

  • Access a larger geographic area.
  • Increase volume and revenue.
  • Provide added value, from capturing digital images of medications for recordkeeping to accessing specialists.
  • Arrange relief coverage for pharmacists. In inclement weather, it can even allow a pharmacist with a hook up at home to check prescriptions.

Is a Community Right for Telepharmacy?

To determine whether a telepharmacy location may be a good fit, begin by answering these questions:

  • Does the community currently have pharmacy (and pharmacist) services?
  • Are there enough prescribers in the area to support a telepharmacy operation?
  • Is there a convenient, cost-effective location available?
  • Would patients, community leaders, medical providers and the state board of pharmacy support a telepharmacy in that location?
Adapted from Peterson, CD, Anderson HC. Chapter 10: Telepharmacy. In: Tracy J, ed. Telemedicine Technical Assistance Documents: A Guide to Getting Started in Telemedicine. Office for the Advancement of Telehealth, 2004:206–240.

Tips for Telepharmacy

State laws and regulations vary, so those are the first things you need to check if you are considering a telepharmacy location. These steps also can lead you toward a successful launch:

  • Ensure local support. MacArdy met with prescribers, the mayor and other local leaders to ensure their backing. Community leaders are often enthusiastic and helpful, Peterson said. “They are proud to say, ‘We have a grocery store and a hardware store and a pharmacy.’” That makes a community more attractive, particularly to families with young children.

    Communities are typically willing to show their support with a shared commitment, which may range from a location to crowdfunding. TelePharm works with influencers and connectors in the community, the local telecommunications and electrical companies, economic developers, and even nursing homes that want a pharmacy in their community.

    When a community has interest in telepharmacy, TelePharm will reach out to a nearby independent pharmacy owner. “We want to help independent pharmacies expand,” Miller said.

  • Hire the right staff. MacArdy puts a certified pharmacy technician in each telepharmacy, although Wisconsin’s law does not make having certification mandatory. He chooses technicians with seasoned input skills and good people skills, since that person represents the pharmacy to everyone who comes to that location.
  • Fine-tune the technology. Telepharmacy requires the ability to transmit images and audio in some way, interfaces with which customers are comfortable, and systems that comply with HIPAA requirements.

    Phillips uses three cameras in its telepharmacy locations: one to keep an eye on the location; one high-resolution overhead camera at the workstation that can zoom in on the dispensing tray and compare the prescription with the medication, and take a photo of the label; and one at the dispensing window that can revolve to face the customer and enable a phone chat with the pharmacists back at Phillips Health Mart in Mauston. Phillips also had to figure out how to manage the inventory for multiple locations through the same database.

    TelePharm provides a cloud-based workflow system specifically designed for telepharmacy operations, including the required secure file storage and video calls. It offers both a full telepharmacy solution and options for telecounseling and checking prescriptions remotely. It provides Bluetooth headsets with noise-canceling microphones for pharmacists and can set up the patient consultations in different ways to accommodate the location.

  • Guarantee a personal connection. With two pharmacists in the retail area of Phillips’ main pharmacy, one is always available to attend to the remote dispensing sites and can see the feed from all six cameras at a glance. Wisconsin law requires pharmacists to consult with patients every time they dispense a medication.

    In addition to its full telepharmacy service, TelePharm has options just for remote counseling of patients and just for remote checking of prescriptions, so it can cater to different models for making a pharmacy’s workflow more efficient and pharmacists more available to talk with customers. TelePharm also recommends the pharmacist be on-site at least once per month.

  • Choose locations carefully. State laws may restrict where a telepharmacy location can be and how many you can monitor from one location, so be strategic about those choices. In general, TelePharm looks for locations with at least 900 residents, but a variety of factors affect the viability of a location, including the distance to the nearest pharmacy. One of the Success Stories on TelePharm’s website is Zearing, Iowa, a town with fewer than 600 residents.

Continuing to Evolve

Already pharmacists are using telepharmacy to deliver medication therapy management and access to specialty assistance, such as asthma experts. In the future, Peterson said, telepharmacy technology may enable pharmacists to connect with patients in their homes to monitor medications and improve adherence. “We have only scratched the surface on what telepharmacy can do,” he said.

Additional Information

The North Dakota Telepharmacy Project offers many resources online. In addition, Peterson recommends that pharmacists who are interested in telepharmacy visit a pharmacy already providing telepharmacy services to see and learn how it is working in practice.

Pharmacy owners also can request a telepharmacy demonstration through the TelePharm website.

Embedding Telepharmacy in a Clinic

Mauston, Wisconsin, has only about 4,500 residents, served by Phillips Health Mart Pharmacy and a Walgreens store. Still, Phillips owner Wayne MacArdy saw an opportunity to open a separate telepharmacy dispensing site in the Mile Bluff Clinic, only about a mile from his main location.

Months before the Mile Bluff telepharmacy opened, a Phillips pharmacist met with the clinic staff for about 30 minutes to explain how the location would work: a technician on-site would be monitored remotely by a pharmacist, who could consult with patients through a computer screen. “The doctors in that clinic were excited to have a place for pharmacy dispensing,” MacArdy said.

The Mile Bluff Clinic is the largest employer in the community, MacArdy explained, and Phillips previously had a location in the clinic for about 20 years, until the pharmacy consolidated operations in 2010. With the threat of a competitive regional pharmacy chain moving into the area, MacArdy decided to reestablish Phillips Health Mart Pharmacy’s presence in the clinic. Telepharmacy allowed him to reopen with a smaller footprint and lower rental costs, in addition to staff savings from having only a technician on-site.

“It’s very much like an apothecary,” MacArdy said of his remote locations, with less than 300 square feet of space and less than $20,000 in inventory on the shelf.

 

1 “Welcome to Telepharmacy,” North Dakota State University. LINK
2 “Do Remote Community Telepharmacies Have Higher Medication Error Rates than Traditional Community Pharmacies?” Journal of the American Pharmacists Association, Sep/Oct 2011. LINK