BETHESDA, MD 25 Jun 2010—The Navy Bureau of Medicine’s investment in telepharmacy is giving isolated Navy pharmacy technicians real-time access to a pharmacist—in some cases, for the first time ever.
Navy Medicine’s telepharmacy project was undertaken to meet the Joint Commission’s requirements for prospective pharmacist review of outpatient prescriptions, said Lieutenant Commander Marc Young, program manager for the project.
The telepharmacy system, by ScriptPro of Mission, Kansas, provides an audio-and-video link between pharmacist-staffed sites and remote pharmacies. Through the link, a pharmacist can view the original prescription and critical dispensing steps, speak with the pharmacy technician, and counsel patients when they pick up medications.
Telepharmacy was examined as an alternative to other options for Joint Commission compliance, including hiring pharmacists to staff all Navy pharmacy sites. Young said the Navy competes with the private sector to hire pharmacists, and both are affected by the current shortage of pharmacists.
As of May, the Navy had 412 pharmacists—113 of them active-duty, 38 reservist, 74 contract, and 187 federal—serving at naval facilities. Pharmacy technicians numbered 1187: 602 active-duty technicians, 41 reservists, 256 contractors, and 288 federal employees.
The telepharmacy rollout began in 2006 with a pilot program in the regions served by Naval Hospital Pensacola, Florida, and Naval Hospital Bremerton, Washington. This past March, the Navy began implementing the telepharmacy system at additional sites around the world.
Young said that by the end of this year, more than 100 Navy sites on four continents will be hooked into the telepharmacy program. He has also been working with Army and Air Force colleagues who are considering telepharmacy for their own services.
"We have a lot of sites, more than the other two services, that have technicians only," Young said of the Navy. "Some of these branch clinics with these technicians are literally almost like closets. They’re very small pharmacies; they’re doing 80 prescriptions a day, in some cases, with one technician."
"It’s difficult to hire folks in those places as well to get people to move to some of our remote locations," Young said.
Through telepharmacy, the technician-run pharmacy at the remote Mountain Warfare Training Center in Bridgeport, California, has access to pharmacists at the Robert E. Bush Naval Hospital in Twentynine Palms, California, Young said.
Farther afield, he said, "we have a site in Souda Bay, Crete, that’s going to be able to talk to the pharmacist in Sigonella, Sicily. And that’s a real-time communications channel that never existed before."
Some of the sites that are networked into the system may have a pharmacist on staff, but that person could be on vacation or ill, or the position may be temporarily vacant, Young said. In such cases, the site is linked to another location that has a staff pharmacist to handle medication reviews and ensure continuity of care.
How it works. Young said that each site’s specific needs are analyzed before the telepharmacy system is deployed to ensure that the equipment and processes fit the site’s workflow.
Once the system is in place, the technician accesses new or refill prescriptions electronically or optically scans written prescriptions received from the patient.
The filling process for the technician involves "scanning the barcode of the product to identify it, capturing images of the pills, of the vial labels, everything that they’re doing," Young said. "They will [then] contact the support pharmacy for a verification."
The pharmacist then performs a utilization review, checks for allergies and drug warnings, and verifies the physical product, including checking it against a standard reference image provided by ScriptPro, Young said.
The pharmacist approves the order after conferring with the technician, if necessary, through the audiovisual link, which includes a telephone handset at the remote site and a headset for the pharmacist. Patient counseling is done through the same audiovisual system, with the pharmacist and patient seeing each others’ faces in real time, Young said.
Pharmacy hubs. In many cases, Young said, pharmacists who review medications are located in Navy hospitals and support one or more branch clinics in the same command. For example, the National Naval Medical Center (NNMC) in Bethesda, Maryland, is the command hospital for the national capital area, which includes northern Virginia, Maryland, Pennsylvania, West Virginia, and New Jersey.
Young said that although NNMC is the "checking site" for the capital area, the region includes a few health clinics whose pharmacists can also check prescriptions for sites in the command. Portsmouth, Virginia, is likewise home to several "very busy" outpatient clinics with multiple pharmacists who check orders for other clinics in that region.
Young said that since most of the hubs have multiple pharmacists on staff, they are usually able to maintain a "one-on-one" relationship with the technicians at the branch clinics. He said the Navy is hiring just four additional pharmacists to keep pace with the new prescription-checking workload from the sites.
Young said the biggest lesson he has learned on this project is to plan early and communicate often with those who will use the system.
"We talk about all the different ideas of what we’ll need to do within the command, in person. Then we actually go around and look at the pharmacy spaces," Young said of the planning process. "Some of these are 30-year-old buildings that we have spaces in. And we need to make sure we have the power plugs, network communication locations."
Once the system is in place, the staff members are trained in its use, and only then can the services go live, he said.
Although Navy hospitals are a crucial part of the telepharmacy program, they do not use the system to handle their own inpatient orders. But Young hopes inpatient use will come in the future.
"I’ve asked to expand the capabilities of the ScriptPro system for our rural hospitals, . . . some in the United States and some overseas," he said. "We’ve requested the funding for that, and we’ll find out, I think, later this year, whether or not it looks very positive or not."