Iso Rx TM Tele Pharmacy Software Daniel R

Iso. Rx TM Tele. Pharmacy Software Daniel R. Halverson Dan. H@Grand. Net. com 4130 Linden Ave, Ste 305 Dayton, OH 45432 937 -254 -9980

Iso. Rx Objectives At the end of this section, you will be able to: 1. Describe how current and future technologies are integrated to provide high quality pharmaceutical care via telecommunications 2. Identify security issues and protection schemes of VPN for Tele. Pharmacy applications 3. Identify the differences between the Tele. Pharmacy concept and Internet drug stores concept

Iso. Rx Concept TM Scenario “One” - Starting a new drug regiment Scenario “Two”- Urgent need: Scenario “Three”- Extinction of rural pharmacies Scenario “Four” - Receiving maintenance drugs by mail Rx

Example Needs Scenario • • • Scenario “One” - Starting a new drug regiment: A mother visiting the rural clinic is told her 8 -month-old baby has otitis media (ear infection) and needs an antibiotic and ear drops. The nearest pharmacy is 40 miles away. She does not have a baby sitter and will need to take a 3 -hour, 80 -mile trip with her sick baby. The complexity of the situation can be multiplied in the Northern Minnesota winter weather conditions. Scenario “Two”- Urgent need: It is determined at the rural clinic that an 80 year old woman needs to change from a 5 milligram dosage of coumadin to a 1 -milligram dosage. She has no transportation. The nearest pharmacy is more then 30 miles away. A remote pharmacy can mail out the new 1 -milligram dosage but it will not arrive for four (4) days. Coumadin is a critical maintenance drug, which thins the blood. Too low a dose can add to the chance of a heart attack and with too high a dose, a patient can bleed to death from a minor injury. The 80 -year-old woman is forced to try to cut the small 5 -milligram pill with a razor blade to make the dosage a 1 -milligram. • Scenario “Three”- Extinction of rural pharmacies: A 66 -year-old rural pharmacist has decides to retire. He has worked in the community his whole life. He has been happy with his lifestyle and income. He does an average of 35 prescriptions a day and sells a variety of merchandise to the community. The next nearest drugstore is 40 miles away, nearly a two-hour drive. He makes $50, 000 a year and is satisfied with this income. He will close his store. No pharmacist will buy a business and take on the responsibilities of business ownership when they can earn $80, 000 annually in urban America as a staff pharmacist. • Scenario “Four” - Receiving maintenance drugs by mail: The elderly in rural northern Minnesota cannot receive the maintenance drug insulin via mail order for a large percentage of the year. Temperatures in their mailboxes will drop to below zero either breaking the container or

Iso. Rx Tele. Pharmacy Concept The Solution - Pharmacy Technician - Client Rx Rx - Formulary - Hardware - Software - Connectivity Staff Pharmacist

Iso. Rx History • Proof of Concept Project (1999) – Concept Developed – Prototype Developed and Integrated – Prototype Tested • North Dakota (Current Project) – Maddock – ND College of Pharmacy

Iso. Rx Tele. Pharmacy Objectives • Increase Pharmacy Prescription Volume – Via Telecommunications – Minimize Cost per Transaction • Maintain Quality Consultations – Personalize Relationship with Local Clients – Apply Same State Certification & Regulations • Compete With Internet Drug Stores

Iso. Rx Proof of Concept Project • Software • Provide Live Video • Provide Monitoring Pictures – Prescription – Spilled Pills • Hardware • Low Cost • User Friendly • Privacy • Connectivity • Virtual Private Network • POTS - Dispensing Container - Final Product

Iso. Rx Applicable Technologies • Virtual Private Network – Private connection between two machines over public network • Turns Internet into simulated WAN – Benefits • Uses Encryption, Authentication, and Access Control for Confidentiality • Local Access, reduces cost • PC Processing Capability (Pentium-Class Systems) – Capable of handling encryption and decryption tasks for high speed transmission lines • Video Capability (High Resolution Cameras)

Iso. Rx Physical Requirements • • • Located at Existing Clinics POTS Telephone Lines (2) Physical Security Pharmacy Work Area (Workstation / Counter Space) Accessibility to the Patients Patient Privacy(Consulting Environment)

Iso. Rx Tele. Pharmacy Model REMOTE PHARMACY PROFILE • 20 -40 prescription per day • Nearest Pharmacy more than 20 miles away PHARMACY STORE PROFILE • 50 prescription per day • Only Pharmacy in area • RPh Staff STAFFING • 1 RPh • 3 Pharm Techs Remote Clinic Remote Pharmacy Main Pharmacy Store

Iso. Rx System Design Architecture Main Pharmacy Large Display 24” + • Windows 98 CPU, P 4, 1. 5 GHz+ 128 Meg of RAM Hard Drive CD read/write 3. 5 disk Drive Speakers/mic. Microphone/Head set Modem • Visual Basic • Iso. RX Software TM Camera “One”

Iso. Rx System Design Hardware Architecture Remote Pharmacy Large Display 24” + CPU, P 4, 1. 5 GHz+ 128 Meg of RAM Hard Drive CD 3. 5 disk Drive Speakers/mic. Modem Camera “Conferencing” Printer Camera “Still Pictures”

Iso. Rx Protocol Overview • Data Exchange - Rx Submitted • Prescription Reviewed • Spill and fill • Data Exchange - Rx Validation • Medication and dispensing container reviewed • Label and information sent to the Remote Pharmacy • Peel and stick • Data Exchange - Rx Consultation • Data Archiving

Iso. Rx Protocol Data Exchange – Rx Submitted • • Patient Submits Prescription / Refill Pharm Tech takes picture of the prescription Pharm Tech informs the RPh of the request RPh reviews prescription and enters data, dosage, DUR (Patient profile and interactions) • RPh submits claim for processing • Once insurance communications and DUR is complete the RPh instructs Pharm Tech to spill and count the Rx

Iso. Rx Protocol Data Exchange - Rx Validation • View and validate drugs being filled • View and validate dispensing containers • Final validation by the RPh

Iso. Rx Protocol Data Exchange - Rx Validation Pharmacy Management Software - claims - interactions - dosage - DUR - etc

Iso. Rx Protocol Data Exchange - Rx Validation • Following RPh Validation • Label and patient information leaflet is printed at the Remote Pharmacy • Financial transaction and dispensing of the medication • Video consultation conducted by the RPh

Iso. Rx Protocol Data Exchange - Rx Consultation • Video and Audio Link between the RPh and the patient • Provides exchange of information of dispensed prescription • Complete all other transactions

Lessons Learned • Prescription Numbers – Best if < 120 prescriptions per day/RPh • Video Conferencing User Interface – Monitor size – Hand held telephone • Picture file formats • Number of remote pharmacy cameras

Iso. Rx Benefits To Patient • Provide needed Pharmaceutical Care to Rural Residents • Eliminates delays in starting a needed drug regiment • Eliminate patient travel • Time • Expense • Avoid northern weather hazards

Iso. Rx Benefits To Pharmacy • Provide needed Pharmaceutical Care to Local Residents • Create viable Pharmacy business model • Requires Only One RPh to Support Multiple Small Pharmacies • Minimum Start-up & Operating Costs

Iso. Rx Questions 1. Key technologies integrated and applied to the Tele. Pharmacy concept. 2. Features of a VPN? Choose all that apply a. Local telecommunication access b. Uses encryption and decryption to provide security c. Used only by large corporations d. None of the above 3. Differences between the Tele. Pharmacy and Internet drug stores?