New KPhA Members

cist uses video technology to monitor the process er clinical service opportunities through telepharto ensure the right medication was labelled for the macy include conducting medication reconciliation right patient. The pharmacist was then also availa- and medication therapy management services ble for video counseling with the patient.3 This tele- (MTMs).6,7 Medication reconciliation services are pharmacy practice could be instrumental in commonly conducted by a pharmacist onsite prior spreading pharmacy care as one pharmacist could to patient discharge. However, one facility found provide services for a few different sites. In this they were able to provide more comprehensive sermanner, telepharmacy could also greatly assist ru- vice by supplementing their onsite staff with teleral institutions in decreasing their operating costs pharmacy staff. This initiative helped ensure all pawhile still providing pharmacy services 24 hours a tients received sufficient discharge instructions and day. helped pharmacy staff catch medication discrepanAnother possible benefit for institutions imple- cies and potential drug interactions.7 Telepharmamenting telepharmacy services, in addition to re- cy has also been utilized to conduct MTMs and to duced staffing pressures, is the opportunity for monitor patients remotely. One company that ofquicker, more efficient medication dispensing. For fers these services described their ability to monitor example, in an integrated hospital system consist- patients more frequently due to telepharmacy. ing of five institutions, centralized telepharmacy With these services, pharmacists assisted patients services were initiated for the hospital system. with adherence problems and potential adverse Pharmacists utilized a private network to access reactions. Upon identifying potential issues, pharhospital data and had pharmacy phone calls routed macists were able to intervene early to help optito them. This arrangement freed up some of the mize the patient’s care.6 nursing staff and was found to reduce the average Though telepharmacy presents many unique opnightly order processing time for routine orders portunities for pharmacists and benefits for pafrom 26.8 minutes to 14 minutes.4 This study tients and institutions, there are also many potendemonstrated that not only can telepharmacy help tial obstacles that may arise when trying to initiate provide pharmacy services more efficiently, but a new telepharmacy service. To ensure the telethat it also can alleviate burdens on other hospital pharmacy service operates as smooth as possible, staff. these potential barriers must be considered ahead Though there are many possible advantages for in- of time and properly managed throughout the prostitutions that use telepharmacy, one may question cess of providing the service. the depth of services a virtual pharmacist could One of the most significant factors that must be provide. Though it may initially seem like telephar- considered in advance of providing service is reimmacy may limit the scope of a pharmacist, there are bursement. This factor may be especially difficult as actually a variety of clinical services that have been different states currently have different regulations successfully provided through telepharmacy. One regarding telehealth services. Further complicating opportunity is for enhanced complex disease state the matter, pharmacists are not currently officially management. For example, one facility developed recognized as healthcare providers by the Centers an asthma education program and delivered it to for Medicare and Medicaid Services (CMS). Consepatients via telehealth. Clinicians virtually met with quently, this lack of designation makes it difficult patients on a regular basis to help with adherence for pharmacists to be reimbursed under traditional and to assess asthma control and found an overall fee-for-service models. However, there has been a improvement in the majority of their patient’s asth- recent push to move towards more value-based ma control by the end of the year-long study.5 In care models which may provide the flexibility to algeneral, telepharmacy provides a unique way to low the realm of telepharmacy to expand.1 meet patients and its convenience may allow more Nonetheless, until there is a major shift in the frequent patient-clinician interactions with ample healthcare reimbursement structure in the United opportunity for thorough counseling. States, pharmacists or institutions considering initiIn addition to medication counseling sessions, oth- ation of telepharmacy services must carefully ex|33| www.KPHANET.org

amine their state’s policies that regulate telephar- personnel factors must also be considered to enmacy practices and reimbursement. One 2016 study sure staff members are sufficient in quantity and examined telepharmacy laws and discussed various properly trained to manage the service. Leadership limitations in telepharmacy in the United States. At structure and the roles each staff member occupy the time, the study found that telepharmacy was should also be examined. One possible consideraauthorized to some extent in 23 states. However, tion in leadership structure is implementing a coormany states vary in the extent of telepharmacy ser- dinator role in the telepharmacy service. One study vices allowed to be provided or set other regula- examined a telehealth model that included an intions that may limit telepharmacy services. For ex- terprofessional team with an “interprofessional care ample, ten states set geographic limits and only coordinator”. This coordinator was key to the proallowed telepharmacy services in areas without a gram’s success in that they helped connect staff traditional pharmacy within a certain driving dis- members and helped acclimate patients to the virtance. Another limitation, six states specify that tel- tual care process. With these essential actions, the epharmacy services can only be provided in certain study found that the coordinator was an essential types of facilities. For example, in Texas, telephar- player in keeping the service running smoothly and macy service is only authorized in rural health clin- in increasing staff members’ confidence in the proics or facilities that are federal or state identified as gram’s viability.9 Delegating another person to “medically underserved”. Lastly, other potential function solely to connect staff members and to state regulations to consider are specifications on manage daily operations could be a vital composupervision, such as how many locations a pharma- nent to ensuring optimal telepharmacy operations. cist can remotely serve at one time, and on interstate services.8 Telepharmacy is a novel extension for pharmacy services and may be discussed for mainstream care gy (IT) support. With the service depending upon technology for its delivery, technology issues could greatly hamper the patient care experience.3 Prior to initiating telepharmacy service, one must ensure they have the proper resources to manage technology infrastructure, to handle potential issues, and to prepare an alternate mode of delivery in the instance of technology outages. Another factor related to technology is the security of patient information. Telepharmacy service will involve a significant amount of private patient information being transferred virtually.3 Management must ensure they have adequate encryption and data protection established before establishing any healthcare service, including telepharmacy. Along with reimbursement and technology factors, even more now in our virtual climate than ever beThough state regulation may be one of the most pertinent factors to address prior to initiating telepharmacy services, there are other factors regarding operation that must be considered. For example, the service is highly dependent upon technology, potentially on both the pharmacist’s and the patient’s end.7 On the patient’s side, some patients may not be equipped with the proper technology or may not be comfortable using it.3 These patient specific factors must be considered when determining the target population for the service. fore. However, aside from today’s shift to a virtual climate, there are many other potential advantages to using telepharmacy as an alternative means of patient care. Telepharmacy can help improve access to rural areas or areas with provider shortages and can help institutions limit costs. Additionally, there are many patient care opportunities for pharmacist through telepharmacy including expanded counseling sessions and complex disease state management. However, prior to initiating a new telepharmacy service one must consider potential barriers to successfully delivering that service, such Additionally, video telepharmacy services would require a strong internet source which may not be available or reliable in rural areas, which are thought to be a prime market for telepharmacy. Another factor to consider is information technolodles. Perhaps most important is considering the team assembled to deliver the service. A comprehensive team of experts will help ensure the patient is receiving the best possible care, regardless of the mode through which it is delivered. as technology difficulties and reimbursement hur|34| Kentucky Pharmacists Association | November/December 2020