The world awoke to one of the most challenging health care disasters in history in December, 2019. The coronavirus disease (known as COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in a matter of weeks, prompting international reactions ranging from mild to aggressive.
With the vast majority of global populations subject to self-quarantine, health care delivery systems took an unplanned detour trying to manage this new situation, which impacts both patients and employees. These new challenges to ensuring the delivery of health care and pharmacy care could continue amid a rapidly reacting political arena, causing significant lifestyle changes worldwide. To ensure patients continue to receive proper treatment during the COVID-19 pandemic, health care professionals must be aware of available technologies and how they can impact patient care.
The Rise of Telehealth
The new norm has significantly impacted individual lives over a relatively short time. From adopting social distancing and working from home, to wearing personal protective equipment (PPE) and homeschooling, COVID-19 has introduced new needs for the American patient population. The important role of health care and pharmacy technologies has been increasingly apparent during this time, starting with the growing need to utilize a fast, efficient, and safe venue to deliver non-urgent medical care and consultation.
The number of telemedicine visits has rapidly and significantly increased following the US declaration of a national emergency due to COVID-19, and this trend is likely to continue even beyond this emergency. Many health care institutions have introduced such services to their patients in an attempt to expand the footprint of health care provision, and deliver more convenient options for patients. As a result of the coronavirus pandemic, more individuals have been exposed to this technology, and likely enjoyed the associated benefits. With some authenticated predictions suggesting social distancing will remain in effect for an extended period following the COVID-19 crisis, health care institutions should plan for a surge in demand for telehealth services, including telemedicine visits, medical consultations, clinical pharmacy consultations, pharmacy medication therapy management (MTM), remote prescription dispensing devices (ie, kiosks), and contactless prescription home deliveries.
The list of required services continues to grow as additional regulatory and economic developments unfold. For example, health care workers’ ability to provide care from home requires supporting technologies. The ability to video-chat with coworkers and patients is paramount. Health care institutions realized this benefit when physicians, pharmacists, and other health care providers were asked to work from home as much as possible to enhance social distancing. Over the next months and years, it is expected that the demand on such workflows and technologies will continue to grow. Working at home saves on overhead costs of having an employee on the company’s premises, and may be more convenient for employees. With the evolution and rapid adoption of centralized order entry/verification, hospital pharmacies should plan to move into the telepharmacy phase, either partially or fully.
Throughout the coronavirus pandemic, several significant regulatory changes have taken place to allow health care practices access to and control over available resources. Examples include waiving certain licensure requirements and limiting prescribing of critical COVID-19 medications.
Shifting to the new norm, it is expected that additional regulatory changes will occur to facilitate safe medication handling and delivery of health care. For example, accommodations will be necessary for services switching to touchless mail order and contactless prescription deliveries. Third-party payors are expected to follow suit and begin covering associated costs and technologies. Thus, health care and pharmacies should be prepared for this change from planning and budgetary perspectives. Expanding mail order services and implementing after-hours automated medication dispensing and counseling are two approaches that can be considered in the short-term. Long-term initiatives may include comprehensive plans, such as robotic deliveries (ie, drones) and centralized, fully automated drug dispensing.
COVID-19 serves as a reminder of the pivotal role infection control and prevention play in health care institutions on a daily basis. As additional clinical and pharmacy surveillance protocols are developed, there will be a growing need for supporting technologies. Institutions must start considering the various infectious disease modules available on the market and evaluate the ones that best integrate with their health care IT infrastructure. Note that utilizing an existing product that serves the current need may not prove to be scalable to cover other aspects, such as those discovered during the coronavirus pandemic. It is also critical that users are trained well and early on using such products to prepare for future national emergencies. Examples of such modules include patient/provider infection tracing, reporting, and expanding data feeds from the EHR into the clinical surveillance systems.
COVID-19 has introduced challenges in acquiring the PPE normally used by sterile compounding personnel. Furthermore, the availability of certain active pharmaceutical ingredients (APIs) has been impacted due to logistical issues related to importing and transportation. Both factors have led many state boards of pharmacy to relax certain rules and regulations, such as those related to the type and shelf life of PPE to be used while conducting sterile compounding procedures.
One innovative idea that has come into play regarding PPE availability is three-dimensional (3D) printing. This approach has shown great promise in fulfilling PPE needs during the coronavirus pandemic, and is likely to continue to grow as a viable, local alternative to standard manufacturing of this equipment. Pharmacies should continue to monitor utilization of PPE (gowns, gloves, goggles, etc) in the sterile compounding areas, and evaluate against market availability of such products.
To reduce personnel exposure to pharmaceuticals during the compounding process, pharmacies have maximized the utilization of their available automation. In addition, pharmacies have created certain staffing models that attempt to keep members of the same team working together at the same shift, which reduces the chances of staff mingling and enhances social distancing. Although the staffing models are expected to slowly revert to the original status post COVID-19, it is likely that we will start seeing more incorporation of automated pharmaceutical technologies related to sterile compounding in daily practice. These may range from fully automated systems and robots to semi-automated sterile compounding workflow systems. More pharmacies will also consider moving to a centralized compounding model (ie, central fill) to enhance safety and sterility measures.
Last of all, the coronavirus pandemic has introduced several challenges for operational health care leadership related to measuring the productivity of employees. For example, during times of low hospital census, many health care organizations struggle with current formulas that utilize the number of active employees during a shift against the number of admitted patients. It is critical to remember that various lines of service require a fixed number of staff members to accomplish daily tasks, independent of the patient census. From a financial perspective, this creates an imbalance with productivity metrics that favor asking these service lines to cut down on employee hours or shifts to “improve” the productivity metric. Moving forward, health care and pharmacy delivery systems will need to revisit these models and establish different criteria for employee productivity. New algorithms and tools are likely to evolve to support this change.
Looking to the Future
COVID-19 has forever changed the global health care and pharmacy delivery arenas. These changes and associated supporting technologies are likely to become more visible over the next few years. Keeping abreast of telehealth advancements and other technologies, the availability of PPE and APIs, as well as regulatory changes will ensure pharmacies can continue to provide the services patients require during and after this unprecedented time.
Ghalib Abbasi, PharmD, MS, MBA, is the system director of pharmacy informatics at Houston Methodist Health System in Houston, Texas. His areas of expertise include pharmacy informatics, sterile compounding regulations and technologies, interoperability, health care artificial intelligence, and 340B implementation and utilization. Ghalib received his Doctor of Pharmacy and MS in clinical/hospital pharmacy from the University of Iowa and his MBA from West Texas A&M University.
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