Establishing a Central Order Entry System for Delivering Telepharmacy Services to Remote Rural Hospitals

Abstract

Background: Smaller, critical access hospitals continue to be challenged in finding sufficient pharmacist staffing to deliver quality pharmacy services. Innovative solutions are being explored, including use of technology, to address the problem of access to pharmacy services in remote rural areas. Objective: To describe a new telepharmacy model that is being developed in North Dakota; the model establishes a central order entry site (COE site) that provides 24-hour pharmacist staffing and telepharmacy services to rural critical access hospitals within the state. Methods: Nine rural hospitals in North Dakota established a contractual agreement with a pharmacist-staffed COE site in Fargo to obtain pharmacist staffing and pharmacy services via telepharmacy delivery. Results: All 9 rural hospitals receiving telepharmacy services from the Catholic Health Initiatives (CHI) COE site are critical access hospitals with 25 beds or less and an average of 6625 community population (range 470–16,010); 9986 doses filled per month (range <100–21,000); 1.8 full-time equivalent staff (FTE) pharmacists (range 0–4.6); 1.5 FTE technicians (range 0–3.0); and 0700 hours-1700 hours Monday through Friday service (range consultant pharmacist by phone 24/7 to 0700 hours-2000 hours Monday through Friday, and 0800 hours-1700 hours weekends and holidays). Six are CHI affiliates and 3 are non-CHI hospitals; 4 are Joint Commission accredited. The telepharmacy technology costs at each rural hospital were $25,300. Conclusions: A telepharmacy model that involves a COE site that provides 24-hour pharmacist staffing with pharmacists who are highly trained and skilled in use of telepharmacy technology and dedicate their full-time jobs to delivery of telepharmacy services to remote rural hospitals is an affordable means of delivering pharmacy services to these hospitals.