Telepharmacy has opened up a new area of specialization for Pharmacy Technicians. Through the use of video conferencing and Interactive Voice Response Systems (VRS), Pharmacy Technicians have the opportunity to work closely under the supervision of a licensed Pharmacist located in a distant location to provide critical pharmacy services. These services include: Inpatient Telepharmacy Remote-Order-Entry Review, Remote Dispensing to retail, outpatient and hospital discharge patients, supplying IV Admixtures to hospital inpatients, supplying remote counseling to patients and staffing refill call centers. Read on to learn more about Telepharmacy and the Pharmacy Technician.
What is Telepharmacy?
Telepharmacy refers to the delivery of pharmacy services through some form of telecommunications without the patient or Pharmacy Technician actually being in the physical presence of a Pharmacist. Telepharmacy services are currently being used in retail pharmacies, hospital pharmacies, nursing homes and in many rural settings.
Types of Telepharmacy
#1 – Inpatient Telepharmacy Remote Order-Entry Review
Inpatient Remote-Order-Entry Review refers to the process of having a Pharmacist at a remote location, away from a hospital, who is conducting a review of medication orders prior to the medications being administered by local pharmacy and nursing staff at the hospital.
This enables a Pharmacist’s medication review in real-time 24 hours a day and can help reduce the workload of the inpatient pharmacy staff.
This is referred to as inpatient admission medication reconciliation and allows for the coordination of inpatient, outpatient and retail prescriptions.
During the medication reconciliation process, the patient’s medication list is compared with the physician’s new orders for medications and any medications contained in the patient’s electronic medical record.
The Pharmacist reviews the patient’s documented disease states, allergies to medications and will make recommendations to the patient care team on how to optimize drug therapy.
Inpatient Telepharmacy Remote Order-Entry Review also allows for additional Pharmacist coverage during extremely busy hours of operation and can provide pharmacy coverage during emergencies.
#2 – Inpatient Telepharmacy Review of Discharge Medications
Telepharmacy has been used with great success at certain hospitals during the inpatient hospital discharge process.
During this process, the Pharmacist in a remote location will review all anticipated discharge medications.
As in admission medication reconciliation, the Pharmacist will compare discharge medications with all medications that appear in the patient’s electronic medical record.
He will then review all discharge medications by telephone with the patient and will ensure that the patient has a complete understanding of the rationales for treatment.
He will also identify any potential issues that could lead to the patient’s readmission.
In addition, in order to ensure medication compliance, the Pharmacist will call the patient 48 hours after discharge to ensure that the patient:
- Has filled all prescribed discharge medications
- Understands all medication therapies
- Understands what medical issues could lead to readmission
The Tele-pharmacist will also schedule additional follow-up calls to the patient’s home to discuss any issues or concerns.
Any important information gleaned from the patient during telephone follow-up conversations is then transmitted to the patient’s physicians, the hospital pharmacists and the hospital nursing staff.
A Study of Telepharmacy Follow-up Discharged Hospitalized Patients
In a study of Telepharmacy follow-up of discharged patients, 85% of discharged patients received pre-discharge medication counseling by a Pharmacist.
82% of discharged patients received a follow-up telephone call by a Pharmacist.
All in all, those patients in this Telepharmacy program had a decreased readmission to the hospital rate of 30%.
#3 – Remote Dispensing
Remote Dispensing which is also called retail/outpatient/discharge dispensing refers to a traditional brick and mortar pharmacy staffed by Pharmacy Technicians and supervised by a licensed Pharmacist at a remote location.
The Pharmacist is responsible for supervising the Pharmacy Technicians, reviewing all prescriptions and performing all the regular duties of a staff Pharmacist in a traditional pharmacy.
This is an added benefit for rural locations where the cost of a pharmacist can be shared among several pharmacies in the same area.
#4 – IV Admixture
IV admixture refers to the mixing of a medication into an IV solution bag that is 50 ml or greater.
Once the proper medication mixture has been completed, the IV medication is then administered to a patient in a hospital setting.
Through remote viewing by Telepharmacy, the Pharmacist can review and approve the IV mixture without having to suit up and go into the clean room to approve the IV mixture personally.
This allows the remotely located supervising Pharmacist the ability to participate more in other clinical activities and in additional revenue producing activities.
#5 – Remote Counseling
Remote Counseling refers to a Pharmacist counseling patient as to their medications via a secure, live and interactive video conferencing session.
This can involve not only counseling about medications but can also involve specialized counseling about medical conditions such as diabetes, hypertension, heart disease and HIV/AIDS.
In addition, patients who are being discharged from the hospital can be counseled regarding their newly prescribed and continuing discharge medications.
Common Misconceptions About Telepharmacy
Misconception #1 – Telepharmacy is Dangerous
Many people are under the misperception that the entire concept of Telepharmacy is dangerous for patients.
The fact of the matter is that according to the NDSU Telepharmacy study which studied Telepharmacy in the state of North Dakota, Telepharmacy had a lower dispensing error rate then the national average for community pharmacies.
In addition, Pharmacy Technicians are under the constant supervision of a licensed Pharmacist who continuously watches all the work and activities of every Pharmacy Technician in the Pharmacy.
Specialized HIPAA compliant sophisticated audio/video equipment allows for supervision of every step of the prescription process from intake to data entry to filling prescriptions to final drug verification of the prescription to counseling of patients by the Pharmacist.
Prescription medications never leave the Pharmacy with being fully vetted by the Pharmacist just as would happen in a regular Pharmacy.
Misconception #2 – Telepharmacy Leads to Fewer Pharmacist and Pharmacy Technician Jobs
The reality is that Pharmacists are needed more than ever to supervise all aspects of a Pharmacy Technician’s practice who is involved in Telepharmacy.
A recent study found that in the past 16 years, 16.1% of independent pharmacies in rural areas have closed.
In the NDSU study on the safety of Telepharmacy previously mentioned, the use of Telepharmacy was found to create between eighty and one hundred new Pharmacy jobs which in turn resulted in over twenty-six million dollars in economic development on the local and state levels.
In addition, there are many new Pharmacy Technician positions available in Telepharmacy. For example, in a Telepharmacy Refill Call Center, a Pharmacy Technician’s job description would include:
- Conducting medication reconciliation
- Using scripting to determine the appropriate response to the caller
- Gathering pertinent information for the prescription approval process
- Addressing medication prior authorizations
- Constructing messaging to physician’s offices detailing relevant patient care information
- Performing a medication review at the time of the call
- Following upon issues that require further research or resolutions
- Forwarding all clinical medication questions to the Pharmacist
- Gathering pertinent information from the caller
- Reviewing the electronic medical record
- Maintaining strict patient confidentiality at all times
- Conducting patient chart reviews
- Maintaining and/or exceeding individual and/group call center metrics
- Participating in project teams
- Participating in creating new standards for continuous process improvement
- Demonstrating exceptional communication skills
- Demonstrating active listening skills
- Demonstrating the ability to multi-task and adapt to changes quickly
- Demonstrating the ability to problem solve
- Demonstrating superb customer service skills
- Demonstrating basic computer knowledge and skills
- Demonstrating excellent telephone skills
- Demonstrating a working knowledge of Medical Terminology
- Demonstrating a working knowledge of Pharmaceutical names
- Demonstrating a working knowledge of the chemical names of drugs
- Demonstrating superior knowledge, skill, vision and commitment
- Demonstrating the ability to work both independently and in a team environment
- Demonstrating typing skills necessary to ensure quick and accurate entry of request details
- Demonstrating self-motivation with the ability to work in a fast moving environment
- Having a High School diploma or the equivalent
- Being comfortable with the use of a headset
- Treating patients at all times with kindness
- Being humble at all times
- Passing the Pharmacy Technician National Certification Exam
- Passing enough continuing education credits to maintain the Pharmacy Technician National Certification
- Having at least one year of experience working in a pharmacy
- Having previous experience in a pharmacy call center
- Being able to sit for a prolonged period
- Maintaining an attitude of excellence at all times
- Constantly seeking new and better ways to serve your patients
Misconception #3 – Telepharmacy leads to Pharmacies Closing in Underserved Areas
According to a University of Chicago study in the city of Chicago on the south and West sides of Chicago, approximately one million people in low-income communities lived in “urban pharmacy deserts” without access to a pharmacy.
This included no pharmacies within one-half mile for those without access to car and no pharmacies within one mile for those with access to a car.
Telepharmacies have enabled pharmacies to open up in these “pharmacy deserts” allowing for a supervising Pharmacist to oversee Pharmacy Technicians in several pharmacy locations simultaneously.
Misconception #4 – Telepharmacy Increases the Risk of Drug Diversion and Theft
There are many State and Federal regulations in place to ensure the Telepharmacies actually have a lower risk of narcotics diversion than traditional Pharmacies.
Many states require that Pharmacy Technicians be certified in Telepharmacy or have significant Telepharmacy work experience.
In addition, it is often required that the Pharmacist in Charge (PIC) of a Telepharmacy personally visit the Telepharmacy facility weekly or monthly to examine and verify all orders and to examine all inventories of controlled substances.
Many Telepharmacies have lower inventories and are able to select what medications are dispensed from them.
In some instances, Telepharmacies are restricted from stocking or dispensing narcotics and so are actually less likely to be targets for robberies and internal theft.
Also, Telepharmacies are continuously monitored by high technology HD video cameras and audio surveillance as an additional deterrent to narcotic diversion or theft.
Misconception #5 – Telepharmacy is Experimental and Not Ready for Widespread Use
The use of Telepharmacy in the United States first began in 2001 in the state of North Dakota.
The United States Navy began using Telepharmacy in 2006 and currently uses Telepharmacy in over 100 Pharmacy locations throughout the world.
Twenty three states now allow Telepharmacy and the number of Telepharmacies is growing throughout the United States every day.
Misconception #6 – Telepharmacy Does Not Help In the Treatment of Chronic Medical Conditions Like Diabetes and Elevated Cholesterol
In a published study, the use of Telepharmacy was found to help diabetics administer their diabetic medications, lose weight, lower HbA1C levels and lower low density lipoproteins.
In a survey of the study’s participants, 92% of patients were very satisfied with their Telepharmacy care with 83% indicating that Telepharmacy helped them obtain the care they required.
The study compared 90 patients in rural areas receiving Telepharmacy to 262 patients seen in person and found that those patients treated with Telepharmacy had similar improvement in glycemic control to those patients seen face-to-face at a University Hospital internal medicine clinic.
Telepharmacy provides the opportunity for well paying positions for Pharmacy Technicians as well as the ability to assist in providing Pharmacy services in underserved areas. Pharmacy Technicians also act as team members under the supervision of a Pharmacist in Charge to provide IV Admixtures to hospitals as well as dispensing medications and providing refills to patients. In addition, a Telepharmacy Pharmacy Technician will be responsible for maintaining patient records, sterile compounding, floor stock maintenance, checking for outdated medicines and billing. Numerous studies have indicated that Telepharmacy has been found effective in the treatment of many chronic diseases such as diabetes. Consider Telepharmacy for a rewarding and challenging Pharmacy Technician specialty.