For time-strapped rural hospital pharmacists, implementing a telepharmacy service to supplement a thin staff can be a time-consuming process that often is weighed down by exploring a crucial early consideration: whether to outsource the service or develop a home-grown solution. However, if the experiences of two rural hospital pharmacy directors are representative, commercial vendors and hospital-based telepharmacy services are largely comparable and the choice of one or another arrangement may depend more on individual considerations.

When Dave Johnson, RPh, the director of pharmacy at Cuyuna Regional Medical Center, in Crosby, Minn., began considering a telepharmacy service, he was quickly faced with the “build it or buy it” dilemma. He said the quotes he received from both a commercial vendor and a hospital-partnering arrangement were comparable and well below the cost of hiring a full-time pharmacist. However, he and his staff ultimately felt more comfortable partnering with a hospital.

“We weren’t sure how much hospital practice the pharmacists in a stand-alone telepharmacy facility would have had and felt a hospital pharmacist would be better able to answer questions from a nurse,” he said.

Mr. Johnson’s search to find a partner hospital is indicative of the increasing popularity of telepharmacy services. He initially inquired about receiving the telepharmacy services offered by one of the member sites of the 16-hospital consortium of which Cuyuna Regional Medical Center is part. However, he was told they were at capacity.

“We ended up partnering with another hospital within a health system that is in the same purchasing group as us, although they’re outside of our consortium,” Mr. Johnson said. “Since we already had a relationship with that hospital, it made sense to work with them.”

The “service has been excellent,” he said, and orders are typically approved within 15 minutes of being placed. However, there have been minor medication errors related to the remote order verification service, mostly due to illegible physician handwriting.

“We haven’t converted our entire hospital to a CPOE [computerized prescriber order entry] system,” he noted.

Benefits of Commercial Partnerships

Hospitals with integrated CPOE and electronic medication administration record systems are turning to telepharmacy to meet the government-mandated requirement that nonemergent medication orders be prospectively verified by a pharmacist on a 24-hour basis. Kelly Morrison, the director of product management at Cardinal Health, believes a vendor like hers can take on the burden of ensuring all of the telepharmacy guidelines are met.

“State regulations can be difficult to interpret and subject to change; therefore, hospitals must continually review them to ensure compliance,” said Ms. Morrison, who led a roundtable discussion on telepharmacy at the American Hospital Association’s recent Rural Health Care Leadership Conference, in Phoenix. “Cardinal Health’s Remote Order Entry Service [ROES] meets or exceeds all Joint Commission standards and National Patient Safety Goals, federal and state regulations as well as American Health-System Pharmacists’ guidelines.”

To date, Erin Sherwood, BPharm, the director of pharmacy at the HealthSouth Rehabilitation Hospital of Northern Virginia, in Stoneridge, has had more than 14,000 remote orders processed by Cardinal Health’s ROES telepharmacists. Ms. Sherwood prides herself on responding to medication orders typically within five minutes, and said a quick telepharmacy response time is important to her. Although the average 20-minute turnaround time she has seen with Cardinal’s telepharmacists does not match her own response time, “for most pharmacies, a 20-minute response time is pretty good,” she said.

The $60,000 annual price tag her hospital pays for the Cardinal Health ROES has been more than offset by the estimated $400,000 they saved on in-house pharmacy staff costs, Ms. Sherwood said.

In terms of patient safety, she noted several instances where telepharmacists changed an ordered drug or modified the dose because of potential drug–drug interactions or patient characteristics. Ms. Sherwood said that knowing her patients’ safety is being preserved by the telepharmacists has increased her job satisfaction and improved her quality of life. “I can sleep better at night,” she said, “knowing that someone is watching over my pharmacy orders.”


Ms. Sherwood and Mr. Johnson reported no relevant financial conflicts of interest.