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
[email protected]@ndsu.nodak.edu
Sandy SprafkaSandy Sprafka
[email protected]@ndsu.nodak.edu
(701) 231-8688(701) 231-8688