By Scot Mitchell, MHSA, and Marjorie Nafts, RPh

ST. VINCENT HEALTHCARE, LOCATED IN Billings, Montana, is a 314-bed hospital in the Sisters of Charity of Leavenworth Health System. The hospital administers about 5,600 doses and processes about 1,700 physician orders per day. Located in Harlowton, Montana, Wheatland Memorial Hospital is a critical-access hospital licensed for 25 beds that operates under a management contract with St. Vincent Healthcare. Harlowton has a population of about 900 people, in a county with a population of 2,400 – only 1.6 persons per square mile. In fact, with six to seven per square mile, the cows outnumber the people.

In May 2003, Harlowton’s local retail pharmacy closed. This effectively left Wheatland Memorial-area residents with no ready access est pharmacy was now 45 miles away. Not only were patients inconvenienced, but Wheatland Memorial’s clinic also suffered from a 17% drop in visits. Patients thought, “If I have to drive so many miles to the pharmacy, I might as well see a doctor near it.” Wheatland Memorial’s board of directors made it a priority to develop a solution to the lack of outpatient or retail pharmacy services available to the community. As a stopgap measure, St. Vincent’s began providing Wheatland Memorial with prepackaged, pre-labeled prescriptions for 23 urgent medications, which were dispensed by physicians. However, due to the lack of pharmacy involvement, we needed to find a better solution.

System Selection
After evaluating a few options, we selected Telepharmacy Solutions from the AmerisourceBergen Technology Group. This particular system allowed for redundant patient safety measures, including three separate bar code verifications to ensure the right patient receives the right drug. Using Telepharmacy, St. Vincent’s pharmacists control the dispensing process, and can also interact with and counsel patients via a video phone. We were also pleased to learn that the existing T1 Internet connection between St. Vincent and Wheatland Memorial would serve as the underlying infrastructure for the Telepharmacy system. While considering the system for purchase, we also worked closely with the state board of pharmacy to ensure that we would be in compliance with applicable regulations. After gaining the support of the state board, our pharmacists, and our physicians, we were able to procure the system with the help of two generous grants – one from an anonymous donor and another from a local trust.

How It Works
To install the system, we needed to purchase an additional license for the outpatient pharmacy information system dedicated to Wheatland Memorial, as well as

Telepharmacy’s information system, a videophone system, and two Telepharmacy Solutions ADDS cabinets – a 3.0 and a 2.0. Located at Wheatland Memorial and secured via biometric devices, these cabinets function a bit like candy vending machines and hold up to 80 line items. To stock the Telepharmacy cabinets, St. Vincent pharmacy packages medications in standard plastic bottles labeled with the drug name, strength, quantity, lot number, expiration date, and an identifying bar code.

With the new system, prescriptions are written at Wheatland Memorial and faxed to the pharmacy at St. Vincent. A St. Vincent’s pharmacist, working at a Telepharmacy-networked workstation, enters orders in the outpatient pharmacy information system and evaluates them for allergies, drug interactions, and so on. The pharmacist prints sample prescription labels to verify their content and performs the third-party adjudication to determine a patient’s insurance coverage and copay. Once these processes have been completed, the Telepharmacy information system interfaces with the cabinets at Wheatland Memorial, and the technician on duty at that facility is informed that a prescription is ready to dispense. The technician selects the patient’s name on the cabinet’s touch-screen computer, and the correct prepackaged medication is dispensed from the cabinet.

The technician verifies that the bar code on the bottle matches the bar code on the patient’s prescription, prints the patient specific prescription label, consults with the St. Vincent’s pharmacist to verify which warning labels to affix to the bottle, and then informs the pharmacist that the patient’s copay has been received. At this point in the process, the St. Vincent pharmacist can verify via the camera link that the prescription has been properly filled and labeled, and can counsel the patient in a private room using the videophone.

Implementation
Because we were the first Telepharmacy install in Montana, the biggest challenge was educating our state board of pharmacy about the process. That being said, they were very cooperative and authorized the project as a pilot as new regulations were being formulated. We also needed to acquire a separate pharmacy license for the Wheatland Memorial facility, as well as sort through a few interface issues, in order to complete the implementation. All in all, we have very few day-to-day problems with the system. It works smoothly and is technically very dependable.

Benefits
The ultimate benefits of using the Telepharmacy system are to the community’s residents, who now have improved access to pharmaceutical care. In addition, St. Vincent’s pharmacists are more involved with their patients, which is a professional benefit. Periodic studies show that new patients are able to walk out of the Wheatland Memorial pharmacy with a prescription in less than 15 – and sometimes less than 10 – minutes. Try doing that at a Walgreen’s. In a recent survey, we found the patient-satisfaction rate with the Telepharmacy program to be 4.68 out of five. As for direct bottom-line benefits for the hospitals, there are none, per se, but the Harlowton community’s economy does benefit from the program, because it keeps business in the local area.

Conclusion
On average, we fill about 14 prescriptions using Telepharmacy per day. We have piggybacked on the system – and its fixed costs – to provide couriered medications to patients in the Harlowton area, using the Wheatland Memorial videophone for pharmacist-patient consultations. In addition, we have been able to assist one of our affiliate hospitals with a similar project, and other Montana hospitals are looking to use Telepharmacy to provide after-hours pharmacy coverage in their facilities. So we have been pleased to mentor other facilities as they consider implementing the system.

We are very happy to be the first hospitals to use Telepharmacy in Montana, and we actually received the Montana Health Association’s innovation award, as well as a similar award from the Montana Pharmacy Association, as a result of the program. Our program has been recognized as one that fills a previously unmet need, and it continues to improve health care access for our rural patients. Even though the technology is certainly advanced, the Telepharmacy system works because of the people involved with it; all of them share a passion to provide patients in the Harlowton area with easier access to medications.

Scot Mitchell, MHSA, is the CEO of Wheatland Memorial Hospital, a post he has held since August 2003. He received a master’s degree in health services from the Medical University of South Carolina.

Marjorie Nafts, RPh, serves as the director of pharmacy and the director of respiratory therapy and neurodiagnostics for St. Vincent’s Healthcare, where she has worked for 30 years. She earned her bachelor’s degree in pharmacy from the University of Montana.