Telepharmacy enables the provision of pharmaceutical services through telecommunication technologies between remote sites and central pharmacies. A qualified pharmacist at the central location can review prescriptions, dispense medications, provide counseling, and monitor patients located far away. Telepharmacy improves access to healthcare in rural areas by allowing pharmacist services without travel. However, regulatory issues and operational challenges like technological limitations and increased workload need to be addressed for telepharmacy to be implemented effectively.

1. TELEPHARMACY
By-
Mohammad Asim
Department of Pharmaceutics
DIPSAR

2. INTRODUCTION
• Telepharmacy, a more recent concept that refers to pharmaceutical service
provision, enables healthcare services, such as medication review, patients
counseling, and prescription verification, by a qualified pharmacist for the
patients located at a distance from a remotely located hospital, pharmacy, or
healthcare center.

3. TELEMEDICINE
• WHO definition:
the delivery of healthcare services, where distance is a critical factor, by all
healthcare professionals using information and communication technologies for
the exchange of valid information for diagnosis, treatment and prevention of
disease and injuries, research and evaluation, and for the continuing education of
healthcare providers, all in the interests of advancing the health of individuals and
their communities.
• gaining popularity each year since treatments via telemedical programs seem to
achieve similar outputs as those obtained through face-to-face care.

4. TELEPHATAMCY
• Relatively new concept and refers to pharmaceutical service provision.
• The National Association of Boards of Pharmacy defines “telepharmacy” as
“the provision of pharmaceutical care through the use of telecommunications and
information technologies to patients at a distance”.
• clinical pharmacy services and the dispensing of a prescription at a remote
location without the physical presence of a pharmacist.

5. Services provided by a telepharmacy:
1. medication order review.
2. dispending and compounding.
3. drug information services.
4. patient counseling.
5. therapeutic drug monitoring.
6. 24-hours pharmacy services

6. How does a telepharmacy works?
A clinic in the isolated area is connected to an urban center that has greater access to
pharmacist staff via video conferencing , novel software and automated dispensing
machines.
Patient or the assisting staff ( nurses or pharmacy technicians) may communicate
the prescriptions (eg, fax) from patients who report to these sites to the central site,
The central pharmacist reviews the prescription and releases the appropriate
items at the rural (eg, prepackaged medication from the automated dispensing
machines) and the label.

7. The pharmacy technician or nurse at the rural site then scans the bar code so that
the prescription matches with its label, attaches the label, and supplies it to the
patient.
The pharmacist at the central end can visually monitor the technician or nurse’s
work to ensure that the right medications have been filled and dispensed.
central pharmacist provides a two-way video consultation for the patient to ensure
that they understand the intended medication use and administration.
This addresses any concerns from the patient’s perspectives and enables efficient
patient counseling from the central location.

8. • Automated dispensing machines, however, are not always affordable for small
rural hospitals or clinics.
• These medications are then directly delivered to the nurse by the pharmacy
technician or are dispensed through automated dispensing devices (when
available).

9. Pharmacist involvement in telepharmacy:
• A 2013 study of the impact of telepharmacy services has shown that the
involvement of pharmacists in the remote review of medication orders when the
hospital pharmacy was closed resulted in a decreased number of adverse drug
events reported.
• involvement of pharmacists in telepharmacy models to improve monitoring and
encourage medication compliance can decrease the risk of medication errors,
adverse drug events, decreased medication cost, and the chances for treatment
failure.
• A study from the USA reported that the involvement of pharmacists in
telepharmacy models has assisted in tracking and improving medication error
rates.

10. • The impact of pharmacist involvement was further seen in the number of orders
reviewed, modified, discontinued, or canceled by a remote pharmacist, reduced
order processing time, and saving money.

11. Rule exceptions (north Dakota):
1. Pharmacist on duty under Section 61-02-01-13. The remote site must have a
registered pharmacy technician present and a working computer, video, and
audio link to a pharmacist at the central pharmacy to have the prescription
area open. The communication link must be checked daily and the remote site
pharmacy must be closed if the link malfunctions, unless a pharmacist is at the
remote site.
• The technician must be registered with the North Dakota Board of Pharmacy
and have at least one year of work experience as a North Dakota Registered
Pharmacy Technician.

12. • The technician must be a graduate of an approved pharmacy technician
education program or must make application to the Board, which
demonstrates knowledge and experience in preparation of prescriptions for
dispensing and working with patients.
• The technician will be subject to all rules in Chapter 61-02-07.1, excluding
ratio of pharmacists to pharmacy technicians. A pharmacist may oversee no
more than four remote sites. As dispensing is considered done by the
pharmacist, the pharmacist will be responsible for and held accountable for
the remote site.

13. Security standards for pharmacies under subsections 3, 4, 6, 7 and 9
of Section 61-02-03-01. The pharmacy technician may unlock the
prescription and storage areas. While the technician is on duty, the
prescription area may remain open.
Input of drug information into electronic data processing equipment
under Section 61-02-06-01. The input of drug information shall be done
by a pharmacist at the main pharmacy or if entered by the technician at
the remote site, must be verified by a pharmacist.

14. Advantages:
• Access to healthcare services
• Routine access to prescription medication and access to pharmacists.
• Economic benefits
• starting a new pharmacy store is much expensive
• saves travel time and expense.
• One skilled pharmacist can provide service to multiple sites.

15. • Patient satisfaction
• review patient’s medications without them having to travel.
• Effective patient counseling
• Telepharmacy ensures greater satisfaction of patients with regard to
the pharmacist counseling and time required obtaining medication.
• Minimal scarcity of pharmacists
• During scarcity of pharmacist their work is shifted to nurses and
doctors who are not properly trained for this.

16. Disadvantages:
• Pharmacy regulation laws
• . A number of policy issues, such as the physical location of
pharmacists that provide telepharmacy services, minimum amount of
time that pharmacist must be on site, the types of technology used,
and the roles of pharmacists, pharmacy technicians, nurses, or other
healthcare providers in medication distribution systems, need to be
addressed.
• delay in the implementation of new laws
• Execution and implementation of comprehensive and uniform
telepharmacy law is still a challenge.

17. • Operational difficulties
• Telepharmacy services may only be possible with more
complex and sophisticated equipment with high-speed digital
connection (eg, Integrated Service Digital Network), which are
often limited in rural areas.
• Face-to-face versus remote workflow might often be
overwhelming and less spontaneous for both patients and
healthcare providers.
• An issue with increased workload appears when a single
pharmacist oversees several remote pharmacy sites.

18. • More time, effort, and money
• Start up involves considerable time, effort, and money.
• the integration of telepharmacy systems to the traditional healthcare
systems has not been implemented in countries that use telepharmacy
services. This makes private as well as government healthcare programs
reluctant in funding telepharmacy expenditures..eg- telepharmacy
expenditure is not covered under health care insurance.
• Security
• involves the transmission of personal and health-related information over
the Internet.

19. • Reluctance to use technology
• predominant in elderly people who are suspicious about technology.
• When face-to-face interaction is not present, the pharmacist’s ability
to fully access patient’s condition might be hindered.
• Continuity of care
• Unlike regular pharmacies, the use of unauthorized medications or
dispensing medications without proper prescription is hard to control

20. Indian Prospective:
• if one has to work outdoor of India with Tele-pharmacy certificate of that nation
where patient is situated may be needed.
• There is no current Indian rule on the subjects elevated in the run-through of
Tele-pharmacy in India.