Every American health facility is scrambling to figure out the best way to fight the COVID-19 pandemic. Recently, the CDC suggested that providers use telemedicine whenever possible (bit.ly/2Uklk5x; bit.ly/2U3yrsN). But adopting the technology isn’t as simple as adding some video equipment and smiling for the camera. Here are some implementation tips for making a good start.
Keep it simple. For pharmacists accustomed to treating patients in a traditional brick-and-mortar setting, a rapid transition to telepharmacy may seem daunting. Indeed, there are many barriers that prevent pharmacists from quickly providing all services to patients in a remote fashion, but even simple phone calls enable pharmacists to remotely check in on patients and answer their questions, according to Timothy P. Stratton, PhD, RPh, a professor of pharmacy practice at the University of Minnesota College of Pharmacy, in Duluth. “For patients, telepharmacy can be provided through a number of different formats,” Dr. Stratton told Pharmacy Technology Report.
Keep privacy top-of-mind. There are many reasons why traditional pharmacists can’t quickly switch all of their services to a remote format, but one oft-cited roadblock is privacy requirements such as those stipulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Any communications between provider and patient—video chat, emails and text messaging—have to be compliant with HIPAA, and that isn’t easy to do, acknowledged David Bush, RPh, a telepharmacist and the owner of Medicap pharmacy in Hancock County, Ind. Fortunately, software can go a long way in satisfying the basics of HIPAA, he noted. Mr. Bush’s telepharmacy set-up, for example, employs tablets with proprietary encryption software that ensures any communications are secure. (Of note, federal officials recently extended telehealth services to Medicare patients as a result of the COVID-19 pandemic, and indicated they would stop enforcing some aspects of HIPAA that might impede remote communications.)
Be ready to wrestle with reimbursement. Telepharmacy has a long way to go before it becomes an easy way to work, Dr. Stratton said; beside the issues with HIPAA compliance, there are problems with reimbursement. “Many states do not pay pharmacists for providing telepharmacy services, nor are all private insurers willing to pay pharmacists for providing telepharmacy services.” Fortunately, the Department of Health and Human Services is helping on the payment front by developing and implementing a new payment rule for federally qualified health centers and rural health clinics that provide telehealth services to eligible patients, as reported in Pharmacy Practice News (bit.ly/2EcB4mY). (For more details on reimbursement, see page 6.)
Know your state regulations. Telepharmacists who want to use more than a telephone will have to do some research, because regulations on telepharmacies vary state by state (J Pharm Pract 2020;33:176-182). In Minnesota, for example, pharmacies can use the state Department of Human Services’ Vidyo video conferencing network to provide telepharmacy services, such as medication therapy management, to patients who have a mental health diagnosis, Dr. Stratton said. “But to do so, the pharmacy may need to purchase hardware that is compatible with the state system.”
Be ready for workflow tweaks. Although telepharmacy often can save providers time, they may struggle with time management, noted Dr. Stratton, because telepharmacists often are juggling other responsibilities. For instance, St. Luke’s Hospital in Duluth serves as the hub hospital for the “Wilderness Coalition,” a consortium of small critical access hospitals throughout Northeast Minnesota’s Arrowhead Region. Eight of these small hospitals used St. Luke’s pharmacists to remotely review orders during nights and weekends and then release medications through automated dispensing cabinets at the remote hospitals—all while keeping up with their regular duties at St. Luke’s.
“The hospital had to ensure that those shifts were adequately staffed,” Dr. Stratton said, “so the telepharmacist would be able to focus on the needs of the remote hospitals when needed.”