Joint Commission rules setting standards for hospital pharmacists are irrelevant for some critical access hospitals that don't seek accreditation, the report said.
The burden of setting hospital telepharmacy standards is left to each state's Board of Pharmacy, which must decide how many hours of pharmacy coverage should be minimally required, the physical location of a pharmacist providing telepharmacy services (such as whether a pharmacist can review orders from his home or from another facility), the types of technology that should be used, the minimum time that a pharmacist must be physically at the hospital, and the roles of pharmacy technicians and nurses.
The report's authors interviewed officials at nine state pharmacy boards and summarized the varying policies or lack of policies, at each.
Until recently, the report said, "the primary focus of telepharmacy regulation (by state pharmacy boards) has been on retail settings."
Boards may also be challenged with deciding whether to limit telepharmacy applications to only those hospitals that are truly in rural areas, with only a dozen or so people per square mile.
Market forces have also been an impediment to implementation, the report said. "Competing interests may come into play and provide barriers...Because of competition with commercial pharmacies, current rules governing outpatient pharmacies are very restrictive."
The report described a situation in Texas, where state rules say a hospitals with more than 100 beds must have a pharmacist on duty at all times the pharmacy is open, but smaller hospitals may have part-time services where a pharmacist must visit the facility at least every seven days.
Having a pharmacist provide long-distance supervision of pharmacy technicians at a rural hospital has not been allowed, except through a pilot project run by a commercial company, Envision Telepharmacy.
Envision provides remote order review and entry, after-hours medication provision, electronic supervision of pharmacy techs and after-hours drug information and consultation.
However, the report said, "It was to recruit hospitals into the Envision telepharmacy pilot. Many hospitals had been operating in violation of state board of pharmacy regulations, but were not being cited. For some hospitals, it was a case of not wanting to solve a problem until it became one."
About half the hospitals funded their initial telepharmacy project expenses with state, federal and private foundation grants. Other hospitals funded them from operating budgets. But other hospitals said lack of funds was a barrier to purchasing the latest dispensing equipment.
The need for creative electronic solutions should only increase, said the report's author Casey. Rapid growth in the volume and complexity of hospital medications, expanding duties for pharmacists to manage medications, the rapidly evolving nature of audio visual technologies will make telepharmacy strategies a natural solution for rural hospitals.
The report concluded, "State regulations that allow rural hospitals to make appropriate use of pharmacy technology are needed if telepharmacy is to realize its potential for increasing access to pharmacist expertise in rural hospitals and helping to achieve the overall goal of improving medication safety.