VIEWPOINTS: March/April 2013

Telemedicine in Pharmacy

How many friends do you have on Facebook? How many connections do you have on LinkedIn? How many people do you follow on Twitter? If you use social media, your answer is probably “a lot.” Now how many of those people do you actually see or talk to on the phone? If you’re like us, it’s probably not very many. In social media, online contact often doesn’t translate to “offline” interactions. 

However, that is not true for online interactions between patients and healthcare professionals, which is a good thing. A JAMA study from November 2012 showed that online patient visits with physicians (a form of telemedicine) were associated with higher rates of phone calls and in-person visits with physicians than for patients who did not participate in online visits.

We view this increased online patient contact with healthcare professionals as a huge opportunity for pharmacists to expand their scope of supportive care via telemedicine. The American Telemedicine Association defines telemedicine as:

“The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smartphones, wireless tools and other forms of telecommunications technology.”

With the development of new technologies for home testing with remote monitoring, pharmacists can extend clinical services to patients remotely. Such services include:

  • Blood glucose monitoring.

  • Blood pressure screening.

Pharmacies could sell an entire line of telemedicine products which enable the pharmacist to receive utilization and measurement reports. This support would help patients to stay on track to improve their health status. Many remote health-monitoring products exist, including: 

  • Telcare BGM blood glucose meter — transmits blood glucose data from the patient’s glucose meter to a secure cloud-based app that provides access for clinicians (or caregivers) to review the data and to receive alerts if the patient’s blood glucose is over a threshold, too high, or too low.

  • VitalPoint HOME in-home monitoring — monitors blood pressure, blood oxygen saturation, pulse rate, weight, glucose level, prothrombin time and ratios, temperature, fluid status, and electrocardiogram data, which are then available to clinicians in real time via laptop or cell phone. Some of these vital signs are not necessarily something that a pharmacist can act on, but the availability of this data could certainly make it easier for the pharmacist to help care for the patient.

  • Avaya telehealth and home-care delivery — provides voice and video conference functionality for patients to interact with healthcare professionals.

We view this increased online patient contact with healthcare professionals as a huge opportunity for pharmacists to expand their scope of supportive care via telemedicine. 

Patients using these products could benefit from interaction with a pharmacist. A study funded by the National Heart, Lung, and Blood Institute is looking at pharmacist telemonitoring of patients’ blood pressure compared to usual care by primary-care providers. Six months into the study the researchers found that “home blood pressure telemonitoring with pharmacist case management was effective at improving blood pressure control and at lowering blood pressure over six months.” This study is still ongoing to determine longer-term efficacy as well as evaluation of costs of medications and physician services.

Retail pharmacies are also using technology to expand in-store clinic and general health services as another way to serve patients. Rite Aid recently began offering patients remote access to physicians and nurses through its NowClinic online care service, an Internet-based service of OptumHealth and American Well. Patients visiting a participating Rite Aid location can use the NowClinic technology, with the pharmacist’s assistance, to discuss healthcare concerns and questions. Discussions with a nurse are free of charge for a limited time. Discussions with a physician are $45 for a 10-minute session and can be extended for an additional charge. Physicians may make simple diagnoses and prescribe noncontrolled medications if appropriate, which can then be dispensed at any pharmacy. An electronic record of the conversation can be sent to the patient’s primary-care physician, if he or she has one. 

Currently, 2,500 Walmart and Sam’s Club locations are being outfitted with self-service wellness kiosks from SoloHealth that provide free health screenings such as blood pressure, weight, and eyesight screening. These screenings are not directly tied to the pharmacy, but patients who receive the screenings could easily stop by to talk with the pharmacist about their results. Critics of this type of kiosk argue that they are primarily used as an advertising vehicle, but they do provide some valuable health information and may cause the patient to engage with a healthcare provider. As the FDA considers additional products for OTC status, the availability of patient’s clinical data could help the pharmacist in appropriate product selection.

As with many pharmacist-delivered services, documentation, billing, and payment for services remains a challenge. Many pharmacy dispensing systems do not have the interfaces to store and track the clinical data from these remote monitoring technologies. Two states, Kansas and South Dakota, require Medicaid to cover telemedicine services, including those related to “pharmacological management services.” While these do not specifically call out pharmacists as the providers of these services, this represents one potential source of payment for pharmacists. It would be exciting to see pharmacists being compensated for consultations to help patients stay on goal with telemedicine services that track patients’ blood glucose, blood pressure, weight, etc. Perhaps the sale of these telemedicine devices could include a monthly monitoring and coaching subscription. These devices could be the catalyst we need to begin charging for professional services, including patient follow-up and management. These devices cost more than their stand-alone counterparts, and there may be some challenges with insurance coverage, but innovative technology like smartphones have proven there is broad appeal across all economic groups when it provides clear advantages to existing products.
Regardless of the professional fee we deserve for these services, electronic devices that connect patients and pharmacists can increase patient loyalty to grow our business. It would be interesting to measure whether these devices increase the number of store trips because of the more frequent pharmacist communications that these devices promote.

Telemedicine presents a variety of opportunities for pharmacists to expand their reach in providing and getting paid for patient care. The expected primary-care shortage and increased patient loads with ACO implementation may provide opportunities for pharmacists to expand their patient care services. Now is the time to consider how to get involved in telemedicine as a way to improve relationships with patients to help them manage their disease states. We suggest that you talk with your software vendors about how to leverage their technology to store and track clinical data and about options for billing for telemedicine services. CT

Fred Hamlin is the director of business development, and 
Melissa Sherer Krause, Pharm.D., is a consultant with Pharmacy Healthcare Solutions, Inc., in Pittsburgh, Pa. The authors can be reached at fhamlin@phsirx.com and mkrause@phsirx.com. The authors would like to thank student pharmacists Tina Horn, Duquesne University Class of 2013, and Zach Bishop, Ohio Northern University Class of 2013, for their assistance in research for this article.



Are Pharmacists Healthcare Providers?

Most pharmacists see themselves as healthcare providers, but the Social Security Act does not. This has been cited as a barrier to pharmacists’ participation in new healthcare models, which may include telemedicine. National pharmacy organizations, including NCPA and NACDS, have asked the Center for Medicare and Medicaid Innovation (CMMI) to use its authority under section 1115(A) of the Social Security Act to “expand the role of pharmacists in new ACO models, community-based transitions of care and bundled payment initiatives.” However, the CMMI needs to hear from more of us to make this a reality. For more information, please visit http://innovation.cms.gov/.


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