With ever-increasing regulations governing the review of drug orders before they can be delivered, it can be a challenge to find the right solution that will afford 24-hour pharmacy coverage without breaking the budget. When standard practice requires pharmacist review of all orders, a hospital has only a couple of options. One is to hire additional staff, which can be both difficult and expensive, or look to outsource to a telepharmacy service. Centralizing pharmacy services often provides the needed round-the-clock coverage while allowing staff to focus on patient activities and in the process provide better patient outcomes.
The telepharmacy model can be as simple as a fax machine with one hospital faxing drug orders to a second hospital, where the review process is managed. More advanced systems utilize digital imaging as well as outside vendors.
There are a number of digital imaging systems, also known as physician (or pharmacy) order management systems. These systems provide more sophistication and safety than a fax machine and can interface with a hospital’s ADT information. Because they use digital images, these systems eliminate the dangers associated with illegible faxes. They also have the capability to segregate orders based on “stat” or “urgency”. Digital imaging systems can increase the efficiency and productivity of pharmacies utilizing telepharmacy.
The other telepharmacy option to utilize is an outsourcing service. The outsourced service provider can be down the street or across the country. Because they have access to your pharmacy information system, they are processing orders directly. You can choose the outsourcing approach for all of your orders, to provide back-up during high volume periods, to provide after-hour coverage, or any combination therein.
To determine the best telepharmacy model for your organization, consider the size of your hospital or health-system and the resources available to you. For a small stand-alone hospital, it may be difficult to partner with another hospital so the best option here may be to seek an outside vendor to provide the required services. For larger health systems, the better option may be to establish a central order entry model,utilizing digital imaging systems which feed all orders to one central location for review.
If you have made the decision that telepharmacy is right for your facility, the next major step is selecting the telepharmacy product or service that best suits your needs. Take a close look at the vendors you are considering, take into account how long the product has been on the market, and review the vendor support that is offered. This is especially critical when several hospitals implement one system.
If you choose to implement a digital imaging system for your orders, consider whether you want a solution that is Internet-based,network-based, or stand-alone. IT support needs and interface development will be determined by your choices. Understanding the architecture of the system you select and how it fits in with your hospital’s network is also crucial in making the right choice. Some telepharmacy systems are software-only products while others may be tied to a certain brand of hardware. You may want to consider a system that allows you to use your existing hardware in order to limit your up-front investment costs.
Also to be considered is the scalability of the product and what it allows the pharmacist to do with the orders once the digital image is pulled up on screen. Some systems allow image modification, addition of notes,and offer such features as bar code recognition and optical character recognition. Products that interface with your ADT system can auto-populate the required fields, such as patient name and account number.
You need to understand the services you will receive and what the quality standards are. After sending an order, can you expect to have it entered within 10 minutes, 15 minutes, or will it take more time? How are errors tracked and reported? What back-up features are available?
If you determine an outsourced provider is the best option for your operation, you will want to ensure that their technology will work with your PIS, however, your selection criteria will focus more on the level of service provided. What services are provided, beyond order entry? Is there a contact readily available for questions, such as drug information queries or order questions? It is key to review the outsourcer’s quality and productivity standards. For example, how quickly will they enter your orders, how are mistakes tracked and reported?
Regulatory issues are also a concern, particularly if you rhealth system spans different states or if your outsourcer is out of state.Currently, 16 states have enacted rules allowing telepharmacy, and while nos tates prohibit the practice, regulations do differ from state to state. For example, some states require a licensed prescriber to be on site with a technician who, in turn, is required to have obtained certain accreditations. Check with your state board to become familiar with the regulations in your state.
Telepharmacy solutions increase staff efficiency, while filling a void that may exist due to staffing shortages or limited hours of operation at a particular facility. In many instances, hospitals are using contracted labor or paying staff overtime to cover shifts. With a telepharmacy solution, the use of contract labor and overtime can be minimized. The right telepharmacy solution can help boost productivity while simultaneously relieving some of the staffing pressures.
The pharmacist shortage and the capability to provide24-hour pharmacy services have made telepharmacy products and services an attractive option for many hospitals and health systems. Outsourcing to a telepharmacy solution can prove a cost-effective means of overcoming staffing shortages while providing improved patient care. ■
Noel C. Hodges, RPh, MBA, has served as the director of pharmacy services for HCA Central Atlantic Supply Chain Services since 2005.Prior to assuming his current post, he was the executive director of pharmacy for CJW Medical Center in Richmond, Virginia. He received his BS in pharmacy from Purdue University and his MBA from Strayer University.
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