TECHNOLOGY

Leveraging Telehealth in the Time of COVID-19

Lake Cumberland Pharmacy, in rural Russell Springs, Ky., operates in the epicenter of the nation’s opioid epidemic. Incidence rates there of acute hepatitis C virus (HCV) infections, largely contracted through dirty needles, are more than twice the national average. The pharmacy’s owner, Jonathan Grider, PharmD, estimates the 10-county Lake Cumberland district he serves has 15,000 patients with untreated HCV.

He expanded his five-year-long relationship with St. Matthew’s Specialty Pharmacy—a Louisville provider two hours away by car and the only independent specialty pharmacy in the state accredited by both URAC and the Accreditation Commission for Health Care (ACHC)—in May 2019, to together bring necessary medical care and pharmaceutical treatments to these patients.

That’s when Dr. Grider enlisted telehealth technology to establish a virtual mini-clinic at Russell County Hospital, a 25-bed acute care facility much closer to his store and where the patients live. He has used Zoom and GoToMeeting so far, but expects to shift soon to the ERxDirect platform as soon as it is available to the 1,800 pharmacies within EPIC Pharmacies’ (Nottingham, Md.) managed pharmacy network, possibly by July.

Dr. Grider arranged for hepatologist and gastroenterologist Bennet Cecil, MD, to conduct 25 telesessions from his Louisville practice office every other Tuesday. Patients infected with HCV go to an outpatient clinic on hospital grounds for the virtual sessions. Dr. Cecil also commutes to this facility on alternate Tuesdays to conduct in-person appointments with his large cohort of geographically distant patients.

Summaries of each telesession help Dr. Grider deliver personalized pharmaceutical care in collaboration with the physician. He said the ERxDirect platform will help him delve more deeply into the complex carerequired by these patients by providing ready access to their health records. The system also offers transparent drug pricing information that he noted is so valuable for high-cost specialty medications, and also provides billing codes and support for his collaborative practice agreements with providers. The virtual telemedicine setup also supports full digital medical instrumentation, including tele-stethoscopes, fundus cameras to detect eye disease, and otoscopes to examine ears.

Dr. Grider is convinced the health care team he pulled together is improving care for a vastly underserved population “that would otherwise be left untreated because of few convenient care alternatives. Our upcoming annual review will make data available.”

A study funded by the CDC (bit.ly/ 2Wez5Uc) showed that 95% HCV treatment success rates are common

Community Pharmacies Also Beneficiaries of Telehealth h

Brian Slusser, the cofounder of ERxDirect, sees the technology playing a ying a pivotal role not only in mini-clinics in rural hospitals, but also in comommunity pharmacies during the current COVID-19 pandemic.

Mr. Slusser said he sees telemedicine as important to “better outcomes es of complex patients in the COVID-19 period because it puts a professional’s eyes on them and builds trust more than phone calls. They’re sheltered in place stockpiling 90-day supplies of medications that get delivered, yet they may experience adverse reactions or dosage or stor- age questions that require answers given in a personal way. Our platform positions community pharmacists as members of the health care team team focused on outcomes instead of just as suppliers of medications, and could set ould set a path for them to eventually be paid for patient consultations.” —A.H.—A.H. In the ERxDirect platform, patients sit in a virtual clinic where they video-chat with remote providers.

since 2018—a finding that sparked Dr. Grider to consider using the ERxDirect system to identify and engage more patients who are infected with HCV. “Kentuckians hate ordering refills by a 1-800 number. They want to feel closer to their pharmacist,” he said.

The ERxDirect station in the hospital clinic could attract up to 40 patients daily for telesessions with Dr. Cecil and other distant medical providers in other specialty care areas such as rheumatology, oncology and mental health, Dr. Grider said. The system will ping him when necessary to log in to ERxDirect promptly on his store’s computer for virtual medication consults with these patients. “We could potentially build a

stream of new complex-care patients through these virtual sessions,” he said.

Dr. Grider already is replicating what he did with Dr. Cecil for HCV at two other hospitals, one in May 2020 and the other on July 1, depending on COVID-19 public restrictions. “It’s hardest for us to get patients to their first virtual visit with the doctor. Once they do that, they comply 90% of the time, and that means a predictable revenue stream for the pharmacy,” he added.

Autumn Zuckerman, PharmD, the program director of specialty pharmacy at Vanderbilt University Medical Center, in Nashville, Tenn., called Dr. Grider’s efforts “a really incredible opportunity to bring health care to a rural/ underserved environment. Specialty pharmacy telehealth in this population can improve patient access and adherence to treatment, and significantly help address a disparity in our ability to end the HCV epidemic.

“Patients often have several comorbidities requiring several medications. Being able to view the [electronic medical record] and connect with patients virtually enables pharmacists providing telehealth to better assess the clinical appropriateness of medications.” —Al Heller

The sources reported no relevant fi nancial relationships.

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