Telepharmacy is delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with pharmacist. It is an instance of wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes or other medical care facilities. Rural residents and communities lack easy access to healthcare services often due to geographical and demographical factors. Telepharmacy holds significant promise as a technology to improve access to pharmaceutical care for people living in rural and remote communities. Telepharmacy is quickly becoming an integral part of modern pharmacy practice that has the potential to provide quality pharmaceutical services, such as medication management, dispensing, patient counseling, and drug information. Inherent to the adoption of these practices are legal challenges and pitfalls that need to be addressed. A well-developed system, however, can change the practice of pharmacy that is beneficial to both the rural communities and the hospital or retail pharmacies that deliver these services.

1. NEHA KANSWAMI
G.Pulla Reddy College of Pharmacy
Course : (Swayam) UGC MOOC;Academic Writing
Application number: fa8e0400f0af11e9b29fa7940f9b4a22

2. Telemedicine is the use of telecommunication and information technology to
provide clinical health care from a distance. It has been used to overcome distance
barriers and to improve access to medical services that would often not be consistently
available in distant rural communities.
The World Health Organization (WHO) defines Telemedicine as, “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.”
WHAT IS TELEMEDICINE?
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Telepharmacy is delivery of pharmaceutical care via
telecommunications to patients in locations where they may not have direct
contact with pharmacist. It is an instance of wider phenomenon of telemedicine,
as implemented in the field of pharmacy.
• Telepharmacy services include drug therapy monitoring, patient counseling,
monitoring of formulary compliance with the aid of teleconferencing or
videoconferencing.
• Telepharmacy services can be delivered at retail pharmacy sites or through
hospitals, nursing homes or other medical care facilities.
TELEPHARMACY
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In 2001, North Dakota became the first U.S. state to pass regulations
allowing retail pharmacies to operate without requiring a pharmacist to be
physically present. The next year, state agencies and grants established the
North Dakota Telepharmacy Project, which now supports more than fifty
remote retail and hospital pharmacy sites throughout North Dakota. In this
program, a licensed pharmacist at a central site communicates with remote
site pharmacy technicians and patients through videoconferencing.
Implementation
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5. How Does Telepharmacy Work?
5
Small pharmacies or clinics in remote, isolated areas are connected to a central pharmacy
through novel software, videophone systems, and automated dispensing machines.
Patients bring their prescriptions to the remote sites, which are staffed by either pharmacy
technicians or nurses.
The central pharmacist provides oversight via teleconferencing systems and processes the
prescription faxed from the rural site.
The pharmacist releases several items at the rural site, including the prescription label and
the prepackaged medication from the automated dispensing machine.
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6. STEPS INVOLVED:
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Prescriptio
n arrives at
the
pharmacy.
The
prescriptio
n is filled.
The
pharmacist
verifies the
prescriptio
n.
Live video
patient
counseling
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EVALUATION THE PRESCRIPTION:
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It starts when medication orders
from a physician in a rural
hospital are sent to an urban
hospital pharmacy via a scanning
device. Nursing staff also enter
the medication order into the
patient’s electronic medical
record.

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VERIFICATION:
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The urban hospital pharmacist
reviews the order in the medical
record system against the scanned
copy. This process is used both to
check the accuracy of the order
entry and also to check the
appropriateness of the order. In
order to do this, the pharmacist
must have access to the patient’s
complete medical record.

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IDENTIFICATION OF MEDICINES:
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RESTOCKING OFADM’S
The telepharmacy program
also allows the urban
pharmacist to oversee the
restocking of the automated
dispensing device, using a
specially mounted video
camera. The camera, on a
rolling cart, is positioned
next to the cabinet that needs
to be restocked. In this way,
the urban pharmacist can
actually see down into each
drawer as it is being filled.

11. Step-by-Step Guide to Creating a Successful Program
A. Starting A Telepharmacy
1.General principles & first point of contact
2.License Application (NCPDP National Council for Prescription Drug Programs and
DEA federal Drug Enforcement Administration
3.Assess the Need
4.Develop Community Partners
In determining the level of support for telepharmacy services and defining the scope
of services needed in the targeted community, feedback from the following project
partners may be beneficial:
 Individual Patients
 Senior Citizen Groups
 Rural Health Clinic Personnel
 Community Business leaders
 Local Community Leaders
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 Local Government Officials
 Pharmacist Practicing in the area
 State Board of Pharmacy Administrator
 State Pharmaceutical Association
 School of Pharmacy
5. Secure a Physical Location
a. Criteria to consider for location of retail telepharmacy
services:
 Convenient Access for the Public
 Proximity to other Health Clinic Facilities ,Proximity to
Nursing Homes
 Leased after Development by Local
 Lease space in an existing business.
 Technology Transmission or Connectivity Capabilities in
the Community
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b. Criteria to consider for starting hospital telepharmacy services
B. Planning Construction
1. Retail Telepharmacies
2. Information Technology Considerations
Installation of VPN (Virtual private network)-encrypts all information between
endpoints and protects private info.
3. Personnel Considerations
 Pharmacy Technician
 Licensed Pharmacist
 Patient Considerations
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14. 1. Inpatient (remote order-entry
review)
2. Remote dispensing
(retail/outpatient/discharge)
3. IV admixture
4. Remote counseling
DIFFERENT TYPES OF TELEPHARMACY:
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15.  INPATIENT (REMOTE ORDER-ENTRY REVIEW):
Inpatient telepharmacy refers to a pharmacist at a remote location
performing remote order-entry services for an inpatient pharmacy at a hospital.
The remote pharmacist reviews medication orders before the hospital staff
administers the drugs to the patient.
 REMOTE DISPENSING (RETAIL/OUTPATIENT/DISCHARGE):
A remote-dispensing site, or retail community telepharmacy, is a licensed brick-
and-mortar pharmacy staffed by a certified pharmacy technician. A pharmacist
supervises the technician, reviews prescriptions and performs his or her duties from
a remote location via technology.
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IV ADMIXTURE:
The joint commission on accreditation of healthcare organizations (jcaho)
defines iv admixture as, “the preparation of pharmaceutical product which
requires the measured addition of a medication to a 50 ml or greater bag or bottle
of intravenous fluid.” In layman's terms, iv admixture is the mixing of iv solution
administered to patients in a hospital setting.
REMOTE COUNSELING:
Remote-patient counseling equates to providing patient counseling via a live-
and-interactive video session, or by some means through telecommunications.
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Traditional full
service pharmacy.
Remote consultation
sites.
Hospital
telepharmacy.
Automated
dispensing
machines(ADMs).
TYPES OF TELEPHARMACY MODELS:
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.
Traditional full
service pharmacy
Remote
consultation
sites
Hospital
telepharmacy
Automated
dispensing
machines(ADMs)
These telepharmacy sites
have complete drug
inventories that include
prescription and over the
counter medications
along with other-health-
and beauty aids and other
general merchandise
Prescriptions are
prepared at the central
pharmacy and are
delivered to the rural
sites.
Audio and video
computer links are used
to deliver patient
counseling and education
Hospital pharmacist in
urban medical center
reviews processes and
verifies the prescriptions
that are issued and
electronically sent from
rural hospitals.
Automated dispensing
machine (ADM) is used
to electronically release
the prepackaged
medication.
Pharmacist at a central
location upon receiving
drug order (electronically
or by fax) confirms the
patient profile, conducts
proper drug utilization
review, and finally
instructs the ADM to
release the medication
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ADMs: Pyxis medstation, Omnicell.
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PROTOCOL FOR PROCESSING OF NEW PRESCRIPTIONS:
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Access to
healthcare
services
Economic
benefits
Patient
satisfaction
Effective
patient
counseling
Minimal
scarcity of
pharmacists
Advantages
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• One major benefit is that many areas especially the remote ones that have no
access to pharmaceutical care or pharmacist will enjoy the services due to the
introduction of these services. Telepharmacy is one way that many people
living in remote areas will enjoy especially if they are unable to get basic
experts in the pharmacy care thus reducing the cost of traveling to other places
for the same services. Patients are also counseled, and drug administering is
monitored from time to time.
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24. Disadvantages
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1) Pharmacy regulation laws
2) Operational difficulties
3) More time, effort, and money
4) Security
5) Reluctance to use technology
6) Continuity of care
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25. Conclusion:
 Rural residents and communities lack easy access to healthcare services often due to
geographical and demographical factors.
 Telepharmacy holds significant promise as a technology to improve access to
pharmaceutical care for people living in rural and remote communities.
 Telepharmacy is quickly becoming an integral part of modern pharmacy practice that has
the potential to provide quality pharmaceutical services, such as medication management,
dispensing, patient counseling, and drug information.
 Inherent to the adoption of these practices are legal challenges and pitfalls that need to be
addressed. A well-developed system, however, can change the practice of pharmacy that is
beneficial to both the rural communities and the hospital or retail pharmacies that deliver
these services.
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References:
Angaran DM. Telemedicine and telepharmacy: current status and future implications.
Am J Health Syst Pharm. 1999;56(14):1405–1426. [PubMed]
National Advisory Committee on Rural Health and Human Services. 2006 Report to the
Secretary. Available at: http://ruralcommittee.hrsa.gov/nacpubs.htm. Accessed October 28,
2006.
North Dakota Telepharmacy Project. Telemedicine technical assistance documents: a
guide to getting started in telemedicine. Chapter 10. Available at:
http://telepharmacy.ndsu.nodak.edu/publications/TELEPHARMACY-TAD1.pdf. Accessed
October 10, 2006.
 Peterson CD, Anderson HC. The North Dakota telepharmacy project: restoring and
retaining pharmacy services in rural communities. J Pharma Technol. 2004;20:28-39.
 Retail Pharmacy Management. Telepharmacy making headway in remote states.
Available at: www.retailpharmacymgmt.com/indexpub.cfm?pubid=10. Accessed October
26, 2006.
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 Gulliford SM, Schneider JK, Jorgenson JA. Using telemedicine technology for
pharmaceutical services to ambulatory care patients. Am J Health Syst Pharm.
1998;55:1512-1515.
 North Dakota Telepharmacy Project. Is a telepharmacy right for my
community? Available at:
http://telepharmacy.ndsu.nodak.edu/publications/communitymanual.htm.
Accessed October 9, 2006.
Integrated Pharmacy Research and Practice downloaded from
https://www.dovepress.com/ by 175.103.25.178 on 27-Oct-2016pharmacist’s
perspective on the clinical benefits and challenges.
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28. Acknowledgement
 With great pleasure I pay deep sense of gratitude and heartfelt thanks to
team Academic Writing for their constant encouragement and support.
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29. Feed Back
 A very good learning platform for students pursuing post graduation and
PhD.
 Several software's and various tools were provided for practice which was
very helpful.
 The Animations in the lectures are very helpful and very effective .The
notes provided is very good and clearly structured. Lectures are quite
interesting to listen to and very well delivered. Overall it was a good
learning experience.
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