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Brent I. Fox, Pharm.D., Ph.D and Joshua C. Hollingsworth, Pharm.D., Ph.D.

THE COVID-19 PANDEMIC has significantly impacted the world in many ways, and its repercussions will no doubt continue to be felt for years to come. It may seem like it’s all negative at the moment, and it certainly is the most significant global health and economic event of most of our lives, but time will tell if any good will result. While the lives lost and personal hardships brought about by the pandemic are truly devastating, and there is no positive spin to place here, there may be some lessons learned. In business, it could be that this experience forces us to make changes in business, education, and healthcare practices that, when reflected upon in the not-too-distant future, are objectively seen as legitimate alternatives. Necessity is the mother of invention. The temporary move to remote meetings, remote education, and remote healthcare delivery was a necessary one. But this seemingly temporary shift that we were all forced to make may lead to the discovery of better, more effective approaches and new best practices, resulting in lasting change and progress. One specific area in the world of pharmacy that is being impacted significantly, at least temporarily, and that is in need of advancing, is telepharmacy. Telepharmacy has the potential to increase healthcare delivery while decreasing viral spread. We will define telepharmacy, view its scope before and during the current pandemic, and discuss telepharmacy solutions that you can implement today.

TELEPHARMACY BEGINNINGS


Telepharmacy, which falls under the umbrella of telehealth, refers to the remote delivery of pharmaceutical care and services through the use of information and communication technologies. For instance, telepharmacy can potentially be used to deliver various aspects of medication therapy management, chronic disease management, transitions of care, and ambulatory care, all remotely. It can be used for remote order-entry review and IV-admixture review at inpatient facilities. Telepharmacy can be used extensively in retail settings. For instance, an off-site pharmacist using a complete telepharmacy solution can remotely review prescriptions and supervise on-site technicians to ensure proper procedures are followed, including in the dispensing of medications. Remote patient counseling and drug utilization review are other common telepharmacy use cases, both in inpatient and outpatient settings. Of course, state and federal regulations must be followed regarding the implementation and utilization of telepharmacy solutions, a point we will revisit shortly.

TELEPHARMACY BENEFITS


Telepharmacy, when properly implemented, offers many potential benefits to pharmacies, pharmacists, and patients. Regarding pharmacies and pharmacists, benefits may include reduced operating costs, increased operational efficiency, the enhanced clinical role of pharmacists, and the ability to work remotely. In regards to patients, telepharmacy expands access to healthcare services, primarily in rural and medically underserved areas, eliminating barriers to patient care and improving patient outcomes. Another obvious benefit for patients, pharmacists, and pharmacy staff during the current COVID-19 pandemic is that telepharmacy eliminates the need for face-to-face contact, thereby decreasing infection risk and helping to “flatten the curve.” In this way, it enables patients safe access to their pharmacist, while also protecting pharmacists and pharmacy staff from infection. Acknowledging this, the CDC recommends that pharmacists make every effort to use telehealth and telepharmacy strategies when “providing patients with chronic disease management services, medication management services, and other services that do not require face-to-face encounters.” Pharmacists have traditionally been the most accessible members of the healthcare team. And during this time, patients may be even more reliant on pharmacists for care, given that access to other healthcare providers and services may be limited. In rural areas, pharmacies may be the only location open for essential healthcare needs.

Although telepharmacy has the potential to expand the delivery of effective healthcare services, regulations have historically impeded implementation. As we all know from experience, healthcare is heavily regulated, with the primary purpose of protecting patients. Overall, this is a good thing, but it does have unintended consequences, such as creating barriers to the delivery of healthcare services. Unlike in education and most other businesses outside of healthcare, a pharmacist cannot simply hop on FaceTime, Zoom, or Skype to provide billable services to a patient, at least under normal circumstances. Compliance must be maintained, as appropriate, with Joint Commission standards, HIPAA and other federal regulations, and state regulations, which vary by state. That said, the Secretary of Health and Human Services (HHS), was recently (March 2020) given authority to waive certain restrictions on telehealth during a declared public health emergency, such as the current COVID-19 pandemic. In response, the secretary loosened restrictions regarding the types of devices that can be used for telehealth. As a result, providers can in fact use services such as FaceTime, Zoom, or Skype on their personal devices (e.g., phone, tablet, laptop) to deliver services remotely, currently. But this is a temporary exception, only allowed during declared public health emergencies.

The COVID-19 pandemic has also moved some state boards of pharmacy to temporarily update regulations specifically regarding the application of telepharmacy. Leading pharmacy organizations, including the American Pharmacists Association, the National Association of Chain Drug Stores, and the National Community Pharmacists Association, released a joint set of policy recommendations that are “critical to addressing the COVID-19 pandemic,” many of which relate to telepharmacy, and many state boards of pharmacy have made changes to expand the role of telepharmacy, allowing more activities to be performed remotely. For example, Alabama and Georgia have authorized remote order verification under certain circumstances, and both Tennessee and Texas have authorized the use of telepharmacy for patient counseling, whether or not in-person counseling was performed prior. Again, allowable activities vary by state, and regulations continue to evolve, so be sure to check your state board’s website for the most up-to-date information for your location. Also, keep in mind that most changes are temporary, and will likely be reversed after the declared public health emergency ends.

SOLUTIONS AVAILABLE


There are fully compliant telepharmacy and telehealth solutions currently available that, depending on your needs and current setup, you could implement and use during the COVID-19 pandemic and beyond. ScriptPro Telepharmacy is a complete telepharmacy system that integrates with other ScriptPro pharmacy systems. It includes workflow, prescription dispensing, and electronic tracking controls with audio-visual connection to remote pharmacies, allowing a pharmacist to oversee a technician and counsel patients from a distance. Other solutions focus primarily on services related to virtual patient contact and counseling. TalkWithYourDoc.com, recently launched by Get Real Health (a subsidiary of CPSI), is a web-based telehealth solution that enables videoconferencing and remote file-sharing between patients and providers. It is EHR (electronic health record) agnostic, can connect to many patients’ medical devices, and includes both Android and Apple apps. CPSI is offering TalkWithYourDoc.com free of charge to all healthcare providers in the United States, through the end of 2020. CGM ELVI is a similar product produced by CompuGroup Medical. It works with any EHR, offers web-based videoconferencing and file-sharing, and includes Android and Apple apps. It also incorporates a virtual waiting room.

THE TIPPING POINT


We are happy to see regulations being relaxed in order to accommodate telehealth and telepharmacy services, even if the changes are only temporary, as these modalities of healthcare delivery have the capability of expanding care while at the same time limiting viral spread. However, we hope to see permanent regulatory changes that eliminate barriers to the implementation and utilization of telepharmacy — especially across state lines — and that improve patient care, such as the continued ability to use FaceTime, Skype, Zoom, and similar services that are familiar to patients. Might it be that this pandemic is the tipping point for many of the telepharmacy services that pharmacists are uniquely qualified to provide? So, what experience do you have with telepharmacy? What tools have you used or considered using? We welcome your comments. CT

Joshua C. Hollingsworth, Pharm.D, Ph.D., is an assistant professor, Pharmacology and Biomedical Sciences, Edward Via College of Osteopathic Medicine, Auburn Campus, and Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University. The authors can be reached at jhollingsworth@auburn.com.edu and at foxbren@auburn.edu.

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