Telepharmacy: New Jobs, Expanded Opportunities

Telepharmacy is gaining momentum as more pharmacies seek ways to extend their regular business hours, grow their scope of services, or capture a greater share of the market. This is true across the board-for pharmacies in rural communities, in specialty clinics, and in emergency departments.

For pharmacists, this growing interest in telepharmacy translates to more job opportunities and a chance to further demonstrate the value pharmacists can have as an important member of the health-care team.

Adam Chesler, PharmD“The real purpose of telepharmacy is to allow our pharmacists to be in a place they weren’t allowed to be before, a place where we couldn’t afford to have a pharmacist,” said Adam Chesler, PharmD, Director of Regulatory Affairs at Cardinal Health, a company that owns the software TelePharm.

Telepharmacy has been touted as one strategy to preserve pharmacist jobs and expand access to patients, especially in rural areas, but experts say rural communities aren’t the only place where telepharmacy can have value. Chain, health-system, and independent pharmacies can also use telepharmacy to extend their regular business hours or enter new areas of the market-such as HIV clinics, emergency departments, employee-based, or other specialized clinics where there’s a need for a pharmacist but demand doesn’t warrant a full-service store.

“Increasingly, there’s this idea that access is an issue, not only in remote locations but also in urban settings or places where it would be good to have pharmacy services available but where it’s not really economically feasible to put a pharmacy in,” said Edward Rickert, Partner at Quarles & Brady, LLP, a national law firm that specializes in pharmacy law.

More state boards of pharmacy are examining telepharmacy regulations, in part, Rickert said, because of a growing demand for more telepharmacy service opportunities from pharmacies, health-care providers, and employer groups.

He has seen boards examine two different types of telepharmacy models:

• The traditional telepharmacy models, where a brick and mortar pharmacy is staffed by a technician who is supervised remotely by a pharmacist

• Automated dispensing systems that are monitored or used remotely by a pharmacist.

Up next: How telepharmacy creates jobs and expands opportunities

Creating Jobs

Experts say telepharmacy solutions can be a win for pharmacies and pharmacists.

Chesler said a common misconception-one he held before learning about the industry- is that telepharmacy takes jobs away from pharmacists. The reality, he said, is that telepharmacy actually creates more opportunities for pharmacists in areas that never would have been able to fully support a pharmacist before.

“Every time we can add a telepharmacy to these towns, it creates part of a job for a pharmacist. It allows them to have those scripts, it allows them to reach into those communities,” he said. “Every patient who improves adherence-improves  the number of prescriptions that are filled-each one improves the number of pharmacists who are needed.”

Chesler pointed to the success of the North Dakota Telepharmacy Project, a joint initiative by the North Dakota State University (NDSU) College of Pharmacy, Nursing, and Allied Sciences; the North Dakota Board of Pharmacy; and the North Dakota Pharmacists Association. It includes 81 pharmacies across the state: 25 central pharmacy sites and 56 remote telepharmacy sites.

According to NDSU, the project has added approximately $26.5 million in economic development and between 80 and 100 new jobs in the state.

Chesler said telepharmacies are also growing in urban areas where there are low rates of vehicle ownership.
Ken Kester, PharmD, JD, Director of Remote Pharmacy for CHI Virtual Health, said he believes telepharmacy has

Ken Kester, PharmD, JDalso added jobs for hospital pharmacists. He has seen remote pharmacists work with hospitals in two ways: either offering additional support for smaller hospitals or handling routine tasks at larger facilities.
The most common of these two models is using telepharmacy to support small hospitals, which either don’t have a pharmacist or don’t have round-the-clock coverage.

“They go from having no pharmacist at times to having 24/7 pharmacist coverage, so certainly that’s added jobs,” he said.

Kester said as recently as ten to twelve years ago, many hospitals hadn’t even heard of the concept of telepharmacy. But recent surveys now show most small hospitals now use telepharmacy routinely.
The other model, although not as extensive, is used by larger hospitals that turn to remote pharmacists to support order entry and verification. This frees staff pharmacists up to perform more clinical tasks and activities.

Expanded Opportunities

The potential of telepharmacy isn’t restricted to job creation. Experts say it also gives pharmacists more opportunities to practice at the top of their license.

By design, telepharmacies rely on technicians to fill prescriptions and for other non-clinical tasks. Pharmacists can spend more time on counseling and other patient-focused responsibilities.

“Every time a pharmacist can interact with a patient, there’s a better chance to have an intervention to improve drug therapy, to demonstrate the pharmacist’s value, and to help overall patient care,” Chesler said.

Related article: Telepharmacy pulls hospital through storm

NuCara, a chain of 23 pharmacies primarily in the upper Midwest, operates two telepharmacies in Iowa, and has plans to open a third and one in North Dakota. NuCara also provides all the pharmacy services for four telepharmacies in Illinois, although they don’t own these facilities.

“I definitely think it’s a tool to reach into communities that otherwise would not have access to pharmacist services. That’s really how we look at telepharmacy,” said Brett Barker, PharmD, Vice President of Operations for NuCara.

Ashley Loeffelholz, PharmD, is the Pharmacy Manager of a NuCara hybrid telepharmacy in State Center, IO. Under the hybrid model, Loeffelholz primarily provides telepharmacy services to the State Center location while also working at a regular retail pharmacy in Ames, IO. However, she is on-site at the telepharmacy one day a week to provide immunizations and other clinical services.

Finding time to counsel patients at both stores naturally weaves into her work flow, she said. She spends the same amount of time, if not more time, counseling those patients at the telepharmacy site compared to her traditional pharmacy.

“I think now it’s very user-friendly and patients are pretty happy with it,” Loeffelholz said.
One advantage to working in the telepharmacy is that due to the small- town nature of State Center, Loeffelholz said she’s had more opportunity to work collaboratively with local physicians.

“We’ve launched a couple clinical projects [in Ames] that have been inspired by working closely with the doctors in the towns,” she said. “It’s really helped me grow professionally.”

Expanded patient access

The University of Wisconsin used telepharmacy initially as a way to assist a federally qualified health center that needed help with getting medications at discounted prices for the 340B drug pricing program targeted at the center’s indigent population.

“We got into the telepharmacy realm by trying to figure out how we could get these patients access to medication at their clinic while not incurring the high cost of a pharmacist FTE [full-time equivalent],” said Melissa Ngo, PharmD,  BCACP, Manager of Community Pharmacy Services at UW Health in Madison.
The telepharmacy started at about 20 prescriptions a day and has since grown to about 60 prescriptions a day.
UW Health, which has more than 60 clinic locations, now operates two telepharmacy locations. It has plans to provide services at a third site this summer.

“We can also utilize this technology to improve the efficiency that we can have with our pharmacist. So we can free up our pharmacist’s time to focus on the clinical tasks,” said Joe Cesarz, PharmD, MS, Director of Ambulatory Pharmacy Services at UW Health.

Challenges

Chains, health systems, and independents have seen advantages to the telepharmacy model, but experts acknowledge that there are still obstacles that prevent more widespread adoption of the strategy.
Rickert, who also teaches pharmacy law at the University of Illinois College of Pharmacy, points to legislative and regulatory hurdles that still exist in many states.

“Some states are great. The way their laws are written, the board has the authority to allow pilot projects and other such things to test technology. A lot of states don’t have that,” Rickert said.

Chesler said regulations are fragmented widely across states. Some don’t even have the statutory approval to operate a telepharmacy. He said Cardinal Health is focusing on educating regulators and legislators to try to give more states the opportunity to use telepharmacy as a strategy within their state.

Another challenge is to ensure that high-caliber technicians are employed at these sites since they will be operating at a separate location from the pharmacist who supervise them.

Related article: Telepharmacy offers hospitals dramatic cost savings, reliable results

“You really have to go out on a limb and trust them and trust that they are doing everything in a way you would want it to be done,” Loeffelholz said. “We’ve gotten very lucky. We have great staff able to do that.”
Barker said finding physical space to house telepharmacies can also be a challenge in some areas due to limited available retail space.

Finally, Rickert said some automated telepharmacies could  face challenges related to the distribution of controlled substances via automated technology. This is less of a concern for brick and mortar telepharmacy buildings, but could be a challenge for those telepharmacies relying on automated dispensing systems.
“It’s something that I think the DEA will eventually come around to, but they move slowly in terms of embracing technology,” he said.

Despite the challenges, those in the industry said they expect telepharmacy to continue to grow, further extending a pharmacist’s reach in patient care.

A Day in the Life of a Telepharmacist

Ashley Loeffelholz, PharmD, is the Pharmacy Manager of two NuCara pharmacies in Iowa. The first is a traditional

Ashley Loeffelholz, PharmDretail pharmacy located in Ames, where she spends most of her days. The second is a hybrid telepharmacy located in State Center. Loeffelholz spends one day a week at the telepharmacy site to provide immunizations and other clinical services, but the majority of her time is spent juggling patients at both sites. She shares what a typical day is like for her as a telepharmacist:

At the start of each day, Loeffelholz signs into the TelePharm software that connects her to the audio and visual system that supports the telepharmacy. She does a test call with her technician to ensure the equipment is working properly.

When a prescription needs to be filled at the telepharmacy site, Loeffelholz is notified by a sound that goes off to signal there’s a waiting prescription.

“We first verify the prescription. We check it for accuracy, just like we would at a typical pharmacy, and then all of their patient profile, medication history, allergies. . .  all of that comes across as part of their telepharmacy profile, so we check all of that,” she said.

If it’s a new prescription or she feels a consultation is necessary, she presses a button to mark the exchange as a consult. She is able to provide the consult over a tablet that the technician provides to the patient.
“It looks like you are Skyping with someone except I have the drug information pulled up on the right hand side as they are picking up the drug,” she said.

The patient is also able to request a consult at any time, and typically patients call from both of NuCara’s telepharmacies in Iowa. They are placed into a pool that one of three pharmacists who monitor the system are able to answer.

If a problem or concern is identified with a prescription, there’s a chat option that allows the pharmacist to converse with the technician or notify the technician and patient that the pharmacist plans to call the doctor.
Loeffelholz says the telepharmacy in State Center typically handles anywhere from 30 to 50 prescriptions a day. That volume is comparable if not a little higher than her volume at the traditional pharmacy in Ames.
“I had never heard of a telepharmacy but I was pretty excited to try it out and I’ve been pleasantly surprised with how smoothly everything has gone,” she said.