Telepharmacy could save rural Iowa sites

Computer software links Victor, Brooklyn drugstores

Roby Miller of Iowa City talks to pharmacists Erin Riffel and Bill Alexander, who are in Brooklyn, Iowa, at Victor Drug
Roby Miller of Iowa City talks to pharmacists Erin Riffel and Bill Alexander, who are in Brooklyn, Iowa, at Victor Drug last week. Miller created the software that makes it possible for customers to have a consultation with a pharmacist located at another pharmacy. (Jim Slosiarek,/The Gazette)

Getting prescription medication the same day as prescribed used to be rare, or at least difficult, for Victor resident Marylou Blomme.

She had to call the pharmacy in neighboring Brooklyn and request her medication be delivered the next day. Some Victor residents would drive the 10 miles to get their pills sooner.

“But there are a lot of elderly people in our town, and a lot of them don’t drive, or shouldn’t,” Blomme, 78, said. “So this is a wonderful, wonderful thing.”

Leaning against a counter in the new Victor Drug last week, Blomme relished the opportunity to pick up a prescription in town. Over her shoulder, a wall-mounted monitor sat ready to facilitate a face-to-face consultation with a pharmacist in Brooklyn, had she needed it.

Todd Thompson with his brother Jon Thompson, both of Kalona, opened Iowa’s first “telepharmacy” in Victor on Sept. 26., making it possible to dole out drugs in the 1,000-person community without paying a pharmacist to be on site.

Todd Thompson’s son, Roby Miller, developed the software that has enabled one pharmacist to be in two — or more — places at once via cameras and video monitors.

The Iowa Board of Pharmacy in November 2011 approved a waiver to let the Thompsons open a telepharmacy using Miller’s software instead of costly robotic machines typically required for pharmacies wanting to do business without a pharmacist present.

The waiver is good for three years. If after that period officials agree the experiment was a success, board members could change Iowa law to allow others to use the telepharmacy software without a waiver.

“There is huge potential in this for small communities,” Todd Thompson said. “Smaller communities really struggle without a pharmacy.”

Residents in those towns wait longer for prescriptions or drive more miles to pick them up. In some cases, doctors’ offices close or struggle to recruit young talent, Thompson said.

“We’ve already had other communities contact us,” he said.

But there are no immediate plans to open more telepharmacies.

“We’ll give this time to see how it goes,” Thompson said.

How it works

Todd and Jon Thompson own half a dozen pharmacies in Iowa, but they closed a couple — including one in Wellman on June 1 that was near to their homes and hearts — because they weren’t making money. Many smaller communities, thanks largely to policy changes related to payments for prescription medication, don’t provide enough business to cover the expense of operating a pharmacy and paying a pharmacist,

“We needed to cut our losses,” Thompson said.

Miller said he wanted to find a low-cost solution that would keep smaller towns equipped with pharmaceutical resources.

“So I quit my job — I was working at Pearson in Iowa City as a project manager — and started doing software development,” he said.

What Miller created was a virtual pharmaceutical conduit that uses cameras, monitors and a database of medication names and images to make it possible for a pharmacist in one community to approve prescriptions in another.

“My software enables pharmacists to work remotely, that is the core concept,” Miller said. “It lowers costs because pharmacists are the most expensive part of the pharmacy.”

The differences in the Victor pharmacy aren’t immediately obvious. There still are full-time technicians who take prescriptions, fill them and hand the medication over at a pickup window.

Behind the scenes, however, Miller said they’re capturing images of the drugs being dispensed and sending those pictures to the satellite pharmacist, who reviews the labels, makes sure the pills match, and cross-checks the prescription in the system’s barcoded database.

“If it’s approved,” Miller said, “then it’s ready to be dispensed to the patient.”

Every patient is legally required have the chance to receive counseling from a pharmacist, and Miller’s system offers live video counseling with a pharmacist using a monitor mounted by the pickup counter.

National movement

Miller has launched a business around his new software — Telepharm Technologies — and he’s hoping it will gain statewide and even nationwide exposure.

A growing number of pharmacies have been closing in rural America, primarily due to government policies related to payments for prescription medication, according to national studies. Other states have delved into the world of telepharmacy to try and save those rural businesses, including North Dakota, which has become a leader with an initiative that has churned out dozens of telepharmacies.

Miller said he hopes Iowa will be next. So far, he said, the Victor pilot is going better than expected.

“I have not gotten one support call since we opened,” he said.

The Victor Pharmacy must submit quarterly reports to the state’s Board of Pharmacy showing usage and accuracy rates.

Terry Witkowski, executive officer for the board, said the business owners had to get a waiver to open the telepharmacy for two reasons. State law restricts telepharmacies in communities within 15 miles of another full-service retail pharmacy — like the one in Brooklyn, about 10 miles from Victor.

State law also requires telepharmacies to use automated distribution systems, a type of dispensing “robot,” that Thompson and Miller said many business owners like themselves can’t afford.

The state has not received requests to use the new software to open more telepharmacies but, Witkowski said, it could be easier for that to happen if the Victor trial goes well.

“(The board) would consider making a change to the rules if it appears to be justified,” she said.

Concerns raised

There are skeptics of the telepharmacy system who worry about patient and drug safety without a pharmacist on site.

“I have concerns that there might be errors,” said Tess Roetlin, a University of Iowa-trained pharmacist who reopened the Wellman pharmacy in August after the Thompsons closed it. “I’m used to looking at my own pills and my own bottles.”

Roetlin said in-person consultations are important.

“I think people in rural communities would like to be speaking with a pharmacist rather than a computer,” she said.

But Blomme in Victor said she thinks the telepharmacy is a perfect fit for Victor.“And it’s nice to see another storefront with someone in it,” she said.

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