Slide – Title Slide

Good Morning!

As you are all well aware, technology provides the foundation for a variety of applications and functions that can dramatically influence the quality of life in rural areas.

Inland Northwest Health Services is a non-profit organization that provides services to hospitals and other health care providers across the northwestern United States. We have extensive experience in technology-based programs that integrate different solutions to link rural and urban health care providers.

I’m going to focus this morning on the use of technology to improve health care services for rural residents, with a particular emphasis on an application of telemedicine that is providing pharmacy services to rural hospitals.

Inland Northwest Health Services currently connects 32 hospitals to a single integrated information system, all utilizing a common master patient index. Over 20 clinics are receiving health information directly through electronic messaging, allowing them to incorporate this information directly into their electronic medical records. In addition, more than 200 physician offices can view critical health data directly via a virtual private network – anywhere, anytime. More than 500 physicians who conduct rounds in hospitals are accessing their patients medical record wirelessly through personal digital assistants. And we currently have 67 hospitals, clinical and public health agencies connected to our regional telemedicine network.

Here’s a map to give you an idea of how broad that regional coverage is.

This slide demonstrates the types of applications INHS is running over the integrated information and telecommunications system.

Our goals for this integrated system include:
Increasing PHYSICIAN CONNECTIVITY through the Internet

Increasing wireless PHYSICIAN CONNECTIVITY to hospital records

Implementing Computerized Physician Order Entry in major Spokane-area hospitals, in conjunction with KNOWLEDGE BASE SYSTEMS

Increasing connectivity and technology-based services for rural health care facilities and residents.

Now I’m going to talk a specific example, demonstrating how health care can be enhanced for rural residents, and how important technology infrastructure is in delivering these programs.

For almost two years INHS has been operating an innovative program called TelePharmacy, where rural hospitals are obtaining pharmacy oversight and expertise via a telemedicine system.

The telepharmacy program has multiple goals – first and foremost, to enhance patient safety. This program also assures that small rural hospitals are in complete compliance with pharmacy regulations, which require that the hospitals have a certain level of oversight from licensed pharmacists.

Further, the telepharmacy program allows for more efficient use of pharmacist resources, since limited pharmacy staff can provide support to multiple facilities. This sharing of pharmacist services is helping rural hospitals overcome a chronic shortage of these critical health care personnel.

Finally the telepharmacy program has been shown to improve both health outcomes for the patients and financial outcomes for the rural hospitals.

The telepharmacy program is made possible by the innovative, integrated use of three different types of technology:
Videoconferencing – to allow communication and interaction between staff in the rural hospital and pharmacists in the urban hospital;
Electronic medical records – shared between facilities so that urban pharmacists can review the health status of patients about to receive medication; and
Automated dispensing devices – to assist nurses and other non-pharmacists in rural hospitals in administering medications.

Next I’m going to give a brief overview of how the process works.

It starts when medication orders from a physician in a rural hospital are sent to an urban hospital pharmacy via a scanning device. Nursing staff also enter the medication order into the patient’s electronic medical record.

The urban hospital pharmacist reviews the order in the medical record system against the scanned copy. This process is used both to check the accuracy of the order entry and also to check the appropriateness of the order. In order to do this, the pharmacist must have access to the patient’s complete medical record.

If necessary, the urban pharmacist can consult with the rural nursing staff, the ordering physician, or the patient via a telehealth video link.

After the urban pharmacist approves the order, nursing staff in the rural hospital dispense the medication using an automated dispensing device. These computer controlled cabinets contain all the medications typically administered in the rural hospital. The nurse who is administering the medication enters in the patient information, and the drawer containing the correct medication automatically pops open. Not only does this help assure that the patient is getting the right medication, but it also helps assure that the right patient gets billed the right amount.

The telepharmacy program also allows the urban pharmacist to oversee the restocking of the automated dispensing device, using a specially mounted video camera. The camera, on a rolling cart, is positioned next to the cabinet that needs to be restocked. In this way, the urban pharmacist can actually see down into each drawer as it is being filled.

Note – point out camera mounted on top of cart.

The urban pharmacist observes each medication prior to its placement in the cabinet, verifying name, strength, dosage and quantity. This visual verification process has been approved by our state’s Board of Pharmacy, so that the rural hospital no longer has to contract with a pharmacist to come in weekly to reload the cabinet.

The bottom line for the telepharmacy program is this: have we accomplished our goals? Well, because of this program, four rural hospitals are now being supported by experienced hospital pharmacists 24 hours a day, seven days a week. Two additional hospitals will be joining the program in the next several months. This shared coverage is more cost-effective than it would be if they maintained a complete 24/7 staff themselves.

These hospitals administer between 60,000 and 100,000 medication orders each year. The telepharmacists have intervened in 3% of these orders to prevent medication errors. None of the potential errors would have caused harm to the patients, but the fact that the system is catching minor errors demonstrates that it would also prevent serious errors if they were about to occur.

In addition to preventing medication errors, the participating hospitals are seeing improved charge capture due to the use of the automated dispensing devices.

Finally, all of the participating facilities are in full compliance with state Board of Pharmacy regulations.

That’s just one example of the innovative technology projects that INHS has undertaken. You can learn about others at our web site. Thanks for this opportunity to share this information with you.

Telepharmacy: an e-Solution
for Rural Hospitals


Jac Davies
November 17, 2005
Inland Northwest Health Services

Inland Northwest Health Services

32 hospitals, with over 2500 beds, participating in an integrated information system and utilizing a common Master Patient Index
More than 20 clinics receiving hospital, laboratory and imaging data via standard electronic messages
More than 200 offices able to view hospital, laboratory and imaging data via a virtual private network.
More than 500 physicians accessing patient records wirelessly in hospitals via personal digital assistants
67 hospitals, clinics and public health agencies connected to the region’s telemedicine network

Clinical System Usage and Strategy

The integrated information system and common MPI gives the region a foundation for innovative tools, including:
Computerized Physician Order Entry (CPOE)
Clinical Documentation Systems for Nursing Notes
Decision-Support Tools
Anywhere, Anytime Physician Access to Images
Remote Consultations and Support for Rural Residents

INHS Telehealth System

Nursing education with universities and community colleges addressing Nursing Shortages
Rural hospital TelePharmacy program providing remote Pharmacist services
TeleER program remotely assisting rural trauma doctors with ER cases
Physicians provide remote Clinical Consults in Neurology, Pathology and many other areas
Prison Health Services receive specialist care
Statewide Diabetes Education Program Including Native American Tribes

TelePharmacy


The provision of pharmaceutical care through the use of Telemedicine technology, automated dispensing technology, scanning technology and integrated computer systems

Goals of Telepharmacy Program

Enhance Patient Safety
Compliance with State Board of Pharmacy regulations
Efficient use of Pharmacist resources
Alleviate Health Care Personnel shortage
Improve Patient Outcomes
Improve Financial Outcomes

Linking Technology to Improve Rural Health Care

Orders are sent to main pharmacy utilizing scanning devices

Scanned Image

Pharmacist reviews orders received

Accuracy of order entry
Appropriateness
Dosing
Allergies
Interactions
Disease state

Consultations can be done via telehealth video link

Medication dispensing by automatic dispensing devices

ADD* Restocking


The utilization of a remote camera and telehealth technology to oversee automated dispensing device* (ADD) restocking

Fill Lists

Technician will print ADD fill list & scan copy to remote pharmacist
Technician will pull needed medication from inventory in the pharmacy

Restocking

Pharmacist visually insures with the technician that the medication is placed in the proper location in the automated dispensing device

Medication Verification


Pharmacist will visually observe and verify name, strength, dosage form and quantity restocked in automated dispensing device.

Accomplishments

Five rural hospitals now have experienced hospital pharmacists providing 24/7 coverage.
Two more hospitals are joining the program in the next three months.
Telepharmacists have intervened in 3% of each rural hospital’s 60,000 to 100,000 annual medication orders to avoid errors.
Participating hospitals have seen improved charge capture of $50,000-100,000 / yr / facility.
All facilities are now in full compliance with Pharmacy Board regulations.

Urban/Rural Technology Value Model

Thank You!

Daviesjc@inhs.org

www.inhs.org