Dr. Charles D. Peterson
Dean, Professor, and Principle Investigator/Director
North Dakota Telepharmacy Project
North Dakota State University
College of Pharmacy
“Nobody talks of entrepreneurship as survival, but that's exactly what it is and what nurtures creative thinking.” Anita Roddick, cosmetics company founder.
Survival of rural health care is what prompted the innovative North Dakota Telepharmacy Project. In the state of North Dakota approximately two-thirds of the counties are designated as frontier. This designation indicates that there are less than or equal to six people per square mile. Traditionally the primary revenue in community pharmacies results from filling prescriptions. With such scare population and limited opportunity to fill prescriptions one can see why ten to fifteen communities in North Dakota were facing the loss of their pharmacy. Seeing this trend and with concern for the citizens they protect, the North Dakota Board of Pharmacy granted a telepharmacy pilot project for the medically underserved, communities that lacked pharmacy services or were about to lose those services. Through the leadership of Dean Charles Peterson the North Dakota State University College of Pharmacy received a grant to support the development of these telepharmacy sites.
Telepharmacy is a practice allowing audiovisual communication technology to connect, a pharmacist to a remote community, who are separated by a distance. In the case of the North Dakota Telepharmacy Project medically undeserved communities through a licensed pharmacist practicing in their area applied to the State Board of Pharmacy for approval of a telepharmacy location. Each approved community then provided a building for renovation to serve as the pharmacy which would be staffed by a technician and connected with state of the art technology to a pharmacist at a distance. At the telepharmacy location the pharmacy technician receives the prescription, enters the data into the computer, selects the drug product, and counts the appropriate quantity. When the product reaches this stage the pharmacist utilizes the audiovisual communication links to review the work and approve the prescription. At the time the patient arrives to pick up the medication they must communicate with the pharmacist through the audiovisual links to receive counseling and answers to their questions. Dr. Peterson described two significant advantages of this technology in comparison with traditional community pharmacies. First, through the audiovisual communication linkages there is complete documentation of pharmacist authorization including pictures of everything the pharmacist saw and approved. Second, the patient can not leave the pharmacy without talking to the pharmacist so all patients receive medication education counseling.
Initially the project involved ten telepharmacy sites. Four years later there are a total of 57 participating pharmacies including 21 central pharmacies supervising 36 remote telepharmacies (44 are retail and 13 are hospital pharmacies). This growth is an indication of the value to patients and the financial benefits of this type of practice. Pharmacists at a central location are eligible to supervise up to four distance telepharmacies. The model is intriguing to traditional community pharmacies because for each telepharmacy location the prescription volume increases by an average of fifty percent. To contain costs some telepharmacies also utilize a courier service to transport the physical product to avoid the need for two inventories.
“Any time you attempt to do something innovative it isn’t always embraced with open arms,” Dr. Peterson said about the project. He recommends considering alternative ways of practice if they are necessary to support the patient. Dr. Peterson encourages pharmacists, “Don’t be afraid to dream, dream big, come up with alternative innovative solutions.”
After identifying the opportunity and developing the concept the third step in the entrepreneurial process is to determine the required resources. How was this step accomplished with the North Dakota Telepharmacy Project?
In addition to significant time and financial resource investment, the North Dakota Telepharmacy Project required the approval of regulatory agencies. The entrepreneurs, including Dr. Peterson, determined all the resources necessary in a traditional community pharmacy and added to that list audiovisual technology that allowed twenty-four hour a day connection between the central pharmacy and the rural telepharmacy site.
How has this venture been harvested?
Telepharmacy in North Dakota has been absorbed into mainstream operations and the telepharmacists are now considering additional opportunities for this type of venture. Some sites are utilizing pharmacy students in the development of patient care services at remote locations. The sites which utilize courier services have also modified the original model of the telepharmacy, and are successful with their venture.