Hello, Doctor: Considering the Future of Compounding Pharmacies Influenced by Telemedicine
Imagine this: a patient with resistant hypertension is treated with standard diuretic therapy and the addition of a mineralocorticoid receptor agonist. Over the course of the next several weeks and months, the patient undergoes follow-up consultations with her pharmacist to monitor blood pressure levels and adherence to her treatment regimen, and to review the prescription order to determine if the pharmacist needs to extend or revise it.
It sounds like a pretty normal pharmacist and patient interaction—except imagine that the patient is in a remote rural community with no available pharmacist. Instead, the pharmacist is a thousand miles away and able to help this patient with her hypertension through monitoring and teleconferencing technology. This is telemedicine.
The March of Telemedicine in Health Care
Technology and health care are not always friends. Billing systems can be archaic. Patient records can still be bulky carts of folders and paper rather than the ideal of sleek tablets and computers. In most ways, health care lags behind other industries in developing and innovating uses for technology in patient care and administration.
But for the past decade, the tide has been turning in favor of more technology, specifically telemedicine or telehealth technologies. The rise of technology in other sectors has pushed many issues to the forefront of the health care industry—how will health care handle “big data” (all the massive amounts of data produced by computerization and what to do with it)? How will health care handle patient data privacy and safety, especially in a world where even our largest institutions seem at risk of breaches? How will health care streamline its billing, databases, and other systems to eliminate bureaucratic waste, minimize risk, and maximize compliance?1
The rise of telemedicine goes hand in hand with these urgent discussions. The definition of telemedicine is purposely broad. In an earlier time, the term was applied to more efficient use of faxing in health care, but in modern times it has been used to encompass everything from the safe sharing of electronic health records in a digital format to patients using remote monitoring to have consultations with remote providers via teleconferencing technology.
Widespread adoption of telemedicine could revolutionize patient care, reducing health care costs by reducing overhead and playing a major role in improving the crisis for critical access hospitals and improving health care access for rural patients. Today, it’s estimated that more than 62 percent of hospitals have adopted some form of telemedicine technology, but it’s important for pharmacists to remember that this is not a way forward only for hospitals and large providers.2
What the Growth of Telemedicine Means for Compounding Pharmacies
Pharmacy is ripe for growth with the advent of telemedicine. Patient counseling, medication management, refill authorizations, prior authorizations, and dispensing and checking of prescription medicines could all be done remotely via telemedicine technology. Telepharmacy helps pharmacies improve quality of care, access to care and efficiency of care, so generally it is most needed and most successful in areas with a shortage of providers.3
For patients in rural areas or patients with limited mobility, being able to receive treatment and consultations with a pharmacist through telehealth technology can be the difference between getting treated professionally or not getting the right treatment at all. Removing the barrier of access to regular care can pay dividends for overall regional health in remote areas, lessening need for emergency or acute care, which may also be difficult to come by as critical access hospitals shutter across the country.
In the example at the top, a study chronicled in the Journal of the American Medical Association provided a remote blood pressure monitoring device to patients undergoing a treatment regimen for uncontrolled hypertension. The device sent real-time data to a remote pharmacist, who was then able to discuss blood pressure readings with patients and counsel them on their treatment. Patients who used the monitoring device and could avail themselves of telepharmacy counsel were 90 percent more likely to show controlled blood pressure levels at the 6- and 12-month check-in points, and beyond. Since the devices are not in wide use, the costs for each patient were high, but if these types of monitoring devices enter mainstream use and telemedicine becomes the norm, costs would fall significantly.4
Is the Telepharmacy Revolution Already Here?
Truthfully, pharmacists and physicians already know what their patients do when they either lack access to health care or do not find their health care options convenient enough. Most often, they turn to the Internet for self-diagnosis and sometimes even self-dosing with OTC medications or supplements. As CEO of the American Telemedicine Association Jonathan D. Linkous wrote in a paper, the time has already arrived when physicians and pharmacists need to move from “acting as a ‘god’ to a ‘guide,’” helping patients to find reliable online sources and decipher information there. Telepharmacy allows pharmacists to play this role for more patients.5
Of course, there are well-documented challenges to implementing a remote medicine program at a health care provider or pharmacy. There are ethical questions for Internet prescribing, questions of authorization and licensure, and plenty of challenges to explore for health care regulators. There’s also the simple bottom line—implementing a telemedicine program is not a cheap or easy thing to do. Some organizations approach this with feasibility studies and incremental programs, such as Sacred Heart Medical Center’s pharmacy department in Spokane, Washington, which in 2006 piloted a program to connect the center’s pharmacists to nine remote hospitals and has grown into a regional leader today.
For a program to succeed requires the right market, typically where there is a shortage and demand for pharmacists, and commitment from the highest levels to changing the way patient care is conducted. Additionally, all elements of the pharmacy from staff training to IT need to be aligned behind the goal of improving efficiency and access to care through telemedicine technologies.
Paving the Way to Implementing Telemedicine Technology in a Pharmacy Practice
Change does not need to happen overnight. Pharmacists and pharmacy operators can explore incremental steps to prepare for future telemedicine innovations in their own practices, including:
- electronic medical records systems
- automated dispensing via robotics
- use of barcode technology for medication inventory, preparation, compounding, and dispensing (this promotes quality control by enabling pharmacies to track every compound from API through to the patient)
- automated systems to notify pharmacists when serum concentrations in compound medications fall outside of normal range
- keeping up with the changes in FDA regulation and enforcement via app technology
- using social media to create a community where patients can discuss their experiences and treatments, and where pharmacists can help educate patients about care options and engage them to provide better customer service.6
While some of these action items are not true telemedicine technologies in that they don’t directly promote remote care, digitizing and implementing better tracking systems is usually the first step to being able to move to any kind of telemedicine system.
Pharmacies and pharmacists will always be an integral part of the health care process. Understanding how to compound medications that better serve patients and the skills needed to develop effective patient care regimens will ensure that pharmacists have a role to play no matter what technological innovations transform health care in the coming years.
Telemedicine shows no signs of slowing down. It fills so many of the gaps and solves so many problems in the current health care system that providers understand they need to find a way to make the technology work. Telemedicine for pharmacies will experience growing pains and regulatory challenges like any other technological innovation in health care, but when the end goal and end result is far, far better patient care and results, telemedicine is clearly the future.
Pharmaceutica North America is a premier provider of high-quality bulk APIs, unit-dose APIs and custom compounding kits to pharmacists and physicians who offer in-office compounding. Contact us to learn more about our products and how we can assist your practice.
- “Six Tech Trends That Will Shape the Pharmaceutical Industry in 2013,” Dec. 10, 2012, http://www.industryweek.com/emerging-technologies/six-tech-trends-will-shape-pharmaceutical-industry-2013 ↩
- “Telehealth Promises to Reshape Health Care,” March 10, 2015, http://www.hhnmag.com/articles/3648-telehealth-promises-to-reshape-health-care ↩
- “Pharmacy moves into the telehealth world,” Aug. 21, 2006, http://drugtopics.modernmedicine.com/drug-topics/content/pharmacy-moves-telehealth-world?page=full ↩
- “Telemedicine: New technologies, new normal,” Sept. 1, 2013, http://www.pharmacist.com/telemedicine-new-technologies-new-normal ↩
- “The Challenge of Regulating Internet Prescribing,” accessed Oct. 25, 2015, http://www.americantelemed.org/docs/default-source/policy/the-challenge-of-regulating-internet-prescribing.pdf?sfvrsn=6 ↩
- “The Role of Information Technology in Advancing Pharmacy Practice Models to Improve Patient Safety,” Jan. 14, 2013, http://www.pharmacytimes.com/publications/health-system-edition/2013/january2013/the-role-of-information-technology-in-advancing-pharmacy-practice-models-to-improve-patient-safety ↩