Outsource Pharmacist Service to another location or another country

[Epic]

Why not?

Radiology is doing it.

I think it's an exciting idea. It will free up pharmacists to provide more cognitive service while distribution aspect of pharmacy service is being done more cost effectively.

Of course there will be issues with licensures and regs.

This idea alone should frighten some pharmacists who only want to count pills.

I like to change the world.

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[SpirivaSunrise]

Why not?

Radiology is doing it.

I think it's an exciting idea. It will free up pharmacists to provide more cognitive service while distribution aspect of pharmacy service is being done more cost effectively.

Of course there will be issues with licensures and regs.

This idea alone should frighten some pharmacists who only want to count pills.

I like to change the world.

What do you know about radiology?

Sure, I'm up for it. But I can see how the licensing/regs could hold it up in states...especially since the idea of outsourcing is such a touchy subject. And not even just pharmacists looking at it as infringement of their turf...but not so sure how comfortable the public would be. They'd get over it eventually though.

 

[SpirivaSunrise]

And there's obviously no way to outsource everything....so there'll still be opportunities for those are absolutely comitted to retail. It wouldn't all disappear.

 

[PharmDstudent]

It'll be here before you know it in the form of a master's degree in --> PharmA (pharmacist's assistant)

Two problems:
1.) Retail drives the market right now. When retail pays $100/hr, hospitals will pay $95/hr. If pharmacists could/would charge for cognitive services in the retail market, then they could set up those diabetes/warfarin/asthma clinics more readily, which would result in more congnitive jobs.

2.) The pharmacist will no longer have 100% of the responsibility. This could be good or bad. I'm sure the MDs/medical students have plenty of complaints about PAs and NPs.

 

[Priapism321]

I have been hearing about Radiology changing via the mechanism you are describing for the last decade or so. However, there are so many damn Radiologists/Radiology Residents at my current institution, I can't believe it is that widespread (may be an inaccurate assumption, show me something?).

Nonetheless, I say go for it.

 

[confettiflyer]

It'd be great...and I think Epic wants to be CEO of the org that does the outsourcing.

 

[SpirivaSunrise]

I'm still not so sure how you handle the logistics though...especially overseas. How are these pharmacists licensed? Do you depend on the NAPLEX? And in lieu of a state board...who holds them accountable?

 

[WVUPharm2007]

I dunno....Coast Guard?

 

[Aznfarmerboi]

sure we might be able to offer more cognitive skills. . . but how much are our cognitive skills really worth? 30 or 60 an hour? it can go both ways.

 

[Hibiclens]

So I go to the doctor and get a prescription for a Zpak. He hands me a prescription for a Zpak...I take it to the pharmacy. What part of the process would be outsourced??? Order entry? DUR? Patient consueling?

I understand things are headed for electronic rxs...but I have to think manual rxs will always be permissible in case of system failure.

On any of those possibilities...man would the company(ies) take a huge PR hit if the system led to more errors or a mixup with the patient.

This may sound weird or misguided...but I really think a pharmacist will always need to be present to "stand guard" over the percocet,etc.....

There are many ways to cut down on the amount of "filling" pharmacists...but most do so by totally making it more inconvient for the patient to go get the meds in a timely manner.

 

[MountainPharmD]

I guess we will get a prescription, then fly to India to get it input and then jump over to Pakistan to get counseld and then fly back to Mexico to get it filled and then back home.

 

[confettiflyer]

Here's an idea for the retail setting:

1) Physician sends electronic order to pharmacy
2) On duty PharmA checks stock, preps package, etc..
3) At the same time, outsourced PharmD checks pt history, actual Rx, etc... for QA. Gives the greenlight electronically.
4) Package is released. Consultations are handled via broadband voice conference (simple headset at consult window). Or...maybe even a full video conference.


License and C-II dispensation responsibilities would fall to PharmA's, because arguably, you do not need a holder of a 4-year doctorate degree to "stand guard" over a few bottles of oxycodone.

PharmD's would strictly provide cognitive services while the PharmA ensures the right pill is in the right bottle/other acts of dispensation.

Issues to overcome: resistance by existing pharmacists (weak, due to lack of coherence at the national level compared to other health professions), racism on the part of patients regarding consultations, changing of laws, and establishment of an M.Pharm/PharmA 2-year degree program.

What will help: Economic clout of major chain pharmacies...Hiring two PharmA's at $60k/yr who can strictly do dispensation with one outsourced PharmD handling the cognitive portion will effectively double the output for any given pharmacy. Insurance issues can then be handled by minimum wage clerks. Pharm tech's would be phased out eventually and would be replaced by the PharmA's with more rights/privileges.


This idea hinges on a) the creation of a PharmA with proper legal rights, b) the move toward all electronic prescriptions.

Opinions? I just pulled this idea out of my arse.

 

[genesis09]

Right now, ACPE fought a hard battle to get pharmacy down to one degree, the PharmD. I doubt they will support the foundation of another degree. No one can force them to write up accreditation standards for another degree. They were the ones who decided to kill B.Pharm.
In my state, it is perfectly legal for the DUR to be done by a pharmacist who is not at the pharmacy. The pharmacist must have a valid U.S. pharmacist license.

 

[Hibiclens]

Here's an idea for the retail setting:

1) Physician sends electronic order to pharmacy
2) On duty PharmA checks stock, preps package, etc..
3) At the same time, outsourced PharmD checks pt history, actual Rx, etc... for QA. Gives the greenlight electronically.
4) Package is released. Consultations are handled via broadband voice conference (simple headset at consult window). Or...maybe even a full video conference.


License and C-II dispensation responsibilities would fall to PharmA's, because arguably, you do not need a holder of a 4-year doctorate degree to "stand guard" over a few bottles of oxycodone.

PharmD's would strictly provide cognitive services while the PharmA ensures the right pill is in the right bottle/other acts of dispensation.

Issues to overcome: resistance by existing pharmacists (weak, due to lack of coherence at the national level compared to other health professions), racism on the part of patients regarding consultations, changing of laws, and establishment of an M.Pharm/PharmA 2-year degree program.

What will help: Economic clout of major chain pharmacies...Hiring two PharmA's at $60k/yr who can strictly do dispensation with one outsourced PharmD handling the cognitive portion will effectively double the output for any given pharmacy. Insurance issues can then be handled by minimum wage clerks. Pharm tech's would be phased out eventually and would be replaced by the PharmA's with more rights/privileges.


This idea hinges on a) the creation of a PharmA with proper legal rights, b) the move toward all electronic prescriptions.

Opinions? I just pulled this idea out of my arse.

1) A lesser degree to handle the C II's...if that is your case...fine....I just don't see that one happening.

2) All electronic??? Like I said...what if there is a telcom failure or system data loss etc....I can't see the day where a manual handwritten rx is not valid.

3) As stated...what about the error caused by bouncing the rx all around the globe. As a "involved" retail rph....I catch stuff that is sent electronically that only someone who knows my customers/patients would catch.

 

[tm96]

I hope that none of you will ever be in position to make any type of decision like this in the future. Did you not know anything about outsourcing and what it has done to families in this country? Many people are losing their jobs from outsourcing and forcing to move or family get separated due to outsourcing. How many engineers do you know that are now out of a job due to outsourcing to countries like India and China and now having to go back to school to learn another career? Remember how hot engineering jobs demand was in the early 90s? Now that most of them got outsource to other countries, most students coming out of school couldn't find a job. Is this something that you would like to see in your profession in the future? Why are you wasting time sitting there thinking of scenarios where your profession can be outsource?

 

[confettiflyer]

I hope that none of you will ever be in position to make any type of decision like this in the future. Did you not know anything about outsourcing and what it has done to families in this country? Many people are losing their jobs from outsourcing and forcing to move or family get separated due to outsourcing. How many engineers do you know that are now out of a job due to outsourcing to countries like India and China and now having to go back to school to learn another career? Remember how hot engineering jobs demand was in the early 90s? Now that most of them got outsource to other countries, most students coming out of school couldn't find a job. Is this something that you would like to see in your profession in the future? Why are you wasting time sitting there thinking of scenarios where your profession can be outsource?

I'm convinced we can't stop globalization, so this thread serves as a think tank so that we may be ahead of the curve and take advantage. Hell, I'd be concerned if we WEREN'T thinking of scenarios on how our jobs may be outsourced.

And sure, the poor computer programmer or steel worker is out of a job, but what of the company that did the outsourcing? By utilizing India/China's competitive advantage with cheap labor, they are saving money and thus able to invest back into their own business. Hurray for those at the top.

But if you do not choose to be flexible and lack the insight in considering the possibilities, and live in a dream world where you believe your job to be 100% safe, you too will be standing at the EDD office.

 

[confettiflyer]

1) A lesser degree to handle the C II's...if that is your case...fine....I just don't see that one happening.

2) All electronic??? Like I said...what if there is a telcom failure or system data loss etc....I can't see the day where a manual handwritten rx is not valid.

3) As stated...what about the error caused by bouncing the rx all around the globe. As a "involved" retail rph....I catch stuff that is sent electronically that only someone who knows my customers/patients would catch.

For point 2 -- Lots of things are already done electronically. When the insurance is down...well it's down, no one picks up their scripts (because no one wants to pay $150 and then have it rebilled later). Massive telecom failures are rare enough that this part is feasible.

Whoever made the point about the lesser degree is probably correct, but I won't rule it out.

And for point 3 -- As much as I commend you for being involved with your patients, that situation that they are in is a scary one to me. You mean if you call in sick and a pharmacist taking your place were to receive a script from one of these patients...that they would not be able to catch the error?

Or more likely...if said pt is traveling and needs a script filled at the same chain (i'm assuming chain, sorry if it is incorrect), that pharmacist won't catch it either?

 

[VeraShield]

Random thoughts:
* There will be outsourcing. But it won't be overseas outsourcing. We won't need a large amount of cheap labor, but less and more specialized.

* The chains already have central processing and central dispensing plans already drawn up ready to use when they feel it will increase their profit margins. I would imagine PBMs and mail-orders already have all the tools to make it happen as well.

* The first group that may actually use central processing/dispensing I believe will be the independents. It will get to the point where the independents may find it easier just to hire an outside firm (outsourcing) to do their processing/dispensing for them, while they concentrate on service. Since I would imagine they don't want to be dependent on a single company, I could see independents forming a coalition of sorts to make this work.

* I really don't get all this talk of a new degree. When central processing is actually feasible, you'll need less pharmacists at the processing center, and more pharmacists at the "nodes" for consultation.

* I also do not see this coming anytime soon. It requires not only electronic prescriptions, but electronic records, and a universal health database. (There's a reason Google and Microsoft are all hitting this area.) Switching to central processing without electronic prescriptions and a health records database would not make the large turn-over worth it IMHO.

 

[Epic]

Random thoughts:
* There will be outsourcing. But it won't be overseas outsourcing. We won't need a large amount of cheap labor, but less and more specialized.

* The chains already have central processing and central dispensing plans already drawn up ready to use when they feel it will increase their profit margins. I would imagine PBMs and mail-orders already have all the tools to make it happen as well.

* The first group that may actually use central processing/dispensing I believe will be the independents. It will get to the point where the independents may find it easier just to hire an outside firm (outsourcing) to do their processing/dispensing for them, while they concentrate on service. Since I would imagine they don't want to be dependent on a single company, I could see independents forming a coalition of sorts to make this work.

* I really don't get all this talk of a new degree. When central processing is actually feasible, you'll need less pharmacists at the processing center, and more pharmacists at the "nodes" for consultation.

* I also do not see this coming anytime soon. It requires not only electronic prescriptions, but electronic records, and a universal health database. (There's a reason Google and Microsoft are all hitting this area.) Switching to central processing without electronic prescriptions and a health records database would not make the large turn-over worth it IMHO.

Why does this idea only pertain to retail setting?

How about hospital pharmacy operations?

 

[tm96]

Lets see how you all would feel about outsourcing when you start losing your job due to outsourcing. When you no longer be able to make that $100K that you all are enjoying and have to go back to school trying to learn another career while struggling to make the mortgage and the car payments or having to move away from your family to take a job elsewhere or going to school again. The reality of it is outsourcing mostly help the company's executives getting bigger bonus and not much is trickling down to the employees.

 

[confettiflyer]

Lets see how you all would feel about outsourcing when you start losing your job due to outsourcing. When you no longer be able to make that $100K that you all are enjoying and have to go back to school trying to learn another career while struggling to make the mortgage and the car payments or having to move away from your family to take a job elsewhere or going to school again. The reality of it is outsourcing mostly help the company's executives getting bigger bonus and not much is trickling down to the employees.

exactly, so best to be in the position to profit, hence this think-tank we have created.

 

[njac]

Why does this idea only pertain to retail setting?

How about hospital pharmacy operations?

just like you said before - someone can play order entry monkey from home (using Pyxis connect or similar software) freeing up the pharmacists at the hospital to work on clinical duties.

 

[Farmercyst]

There was a company at APhA advertising video verifications for satellite pharmacies. The tech entered the script took pictures of the label and the medication, the pharmacist then verified and passed the script. When the patient needed counseling they could use a video phone built into the register. The clerk would scan the med and the pharmacist could see the Rx, the drug, and the label. In this way it would seem pretty easy to outsource it to anywhere.

 

[psychoandy]

just like you said before - someone can play order entry monkey from home (using Pyxis connect or similar software) freeing up the pharmacists at the hospital to work on clinical duties.

Or just integrate computerized order entry with your pharmacy system of choice, leaving floor RPhs/outsourced monkeys to verify that the provider entered the order correctly...a lot easier said than done, though.

As far as outsourcing hospital pharmacy logistics/distribution...ummm...well i guess you could have a similar thing like an optifill, where you have 2 cameras looking at a med baggie or item or whatever, and have an offsite RPh look and tell you that yes, that item is an advair discus 250/50 or whatever. But I think you would at least have to have a EMAR set up, so you can make sure staff isn't working around the system by grabbing a med off the shelf and sending it to the floor. And I feel like narcotics would still have to be handled by an RPh on site.

Outsourcing admixtures, however, man I can't even imagine. I guess you could do the same thing with a couple cameras, but most RPh's i've seen sometimes question how someone made something. That, and the whole big brother thing is kinda creepy.

Maybe this is a possibility in 10-20 years, but I dunno. Look at like hospital supply; they're more surly and have way more attitude than pharmacy, and all they do is stock things like NS bags and band-aids, relatively easy things to manage and keep track of. I don't see their people getting outsourced by machines anytime soon...but then again my hospital hasn't really been in the red. Anyways, I'm sure they'll be first to get outsourced by surly robots that can keep inventory of emesis basins and foleys in a supply closet. Then, maybe i'll start worrying about my pharmacy clinical/pill counting skillz being outsourced.

 

[confettiflyer]

My university hospital's pharmacy has this gigantic robotic arm the size of a cadillac stocking things...it reminded me of a candy factory i went to a while back, it was interesting.

I wonder how RFID's will help things along as well. I'm waiting for holographics to advance so that a pharmacist at a remote "station" can have everything he needs right there in front of him, and using a specialized glove (ala Tom Cruise in Minority report) he/she can manipulate objects in real time via the on-site robot. Kind of like the remote surgery experiments being done here and there.

Of course, hiring a pharmacist at $120k+/yr is probably cheaper then the millions it would cost, even if the technology were mature enough. The break even point would be too far in the future..by then, if you believe WVU, robots will be taking everything over anyway.

 

[Epic]

just like you said before - someone can play order entry monkey from home (using Pyxis connect or similar software) freeing up the pharmacists at the hospital to work on clinical duties.

smart girl...

 

[Epic]

My university hospital's pharmacy has this gigantic robotic arm the size of a cadillac stocking things...it reminded me of a candy factory i went to a while back, it was interesting.

I wonder how RFID's will help things along as well. I'm waiting for holographics to advance so that a pharmacist at a remote "station" can have everything he needs right there in front of him, and using a specialized glove (ala Tom Cruise in Minority report) he/she can manipulate objects in real time via the on-site robot. Kind of like the remote surgery experiments being done here and there.

Of course, hiring a pharmacist at $120k+/yr is probably cheaper then the millions it would cost, even if the technology were mature enough. The break even point would be too far in the future..by then, if you believe WVU, robots will be taking everything over anyway.

You like this topic don't you.

 

[Requiem]

Of course, hiring a pharmacist at $120k+/yr is probably cheaper then the millions it would cost, even if the technology were mature enough. The break even point would be too far in the future..by then, if you believe WVU, robots will be taking everything over anyway.

Let's say hypothetically 3 million. That is only 25 pharmacists @ $125,000. This doesn't even include fringe benefits, which bring the true cost of a pharmacist up to around $150,000, even $165,000 depending on benefits/401k packages, etc. For one year, to implement something that will cost $3,000,000 but save TONS in cutting pharmacist costs, it's not expensive at all - it's accruing an asset. It'll pay for itself in a short time.

 

[PharmDstudent]

What the hell are y'all talking about? Pie in the sky indeed.
You still have to pay a pharmacist who sits at home. Duh! You can't just not pay someone, because you're outsourcing them. Therefore, your 3 mil investment in a machine will cost more like 3 mil plus X dollars times Y number of pharmacists who have to verify scripts plus their benefits and 401k, etc.

If patients were one-dimensional, then I would consider outsourcing at 100% to be very valuable. However, there are thousands of combinations that could pop up for a pharmacist to manage.
Just a few examples:
- the inventory counts may not be 100% legit
- the nurse lost the meds and needs another dose
- the patient was prematurely D/Ced
- the doctor could mess up the sig by writing the wrong dose/dosage form/frequency (the pharmacist who deals exclusively with the patient will instinctively know that this is wrong while an outsourced pharmacist who verifies one script for this patient won't have a clue unless they had the time to check a patient's chart for every script)
- the patient is coding and needs medications sent up immediately

The outsourced pharmacist would have no control over any of these parameters. Sure... they could verify what the script says, but they wouldn't be able to adjust for changes in follow-through.
*Outsourced pharmacists can't compound!

One more thing: doctors aren't going to want to deal with an outsourced pharmacist. It's the same principle with everything else. Think about what a pain in the *** mail order pharmacy is. Who likes talking to someone in India about their bank statements? People still want to talk to someone directly when they shop for groceries, clothes, cars, etc.

 

[Requiem]

If patients were one-dimensional, then I would consider outsourcing at 100% to be very valuable. However, there are thousands of combinations that could pop up for a pharmacist to manage.
Just a few examples:
- the inventory counts may not be 100% legit
Nor are they when you're actually there - they'd have the same comp. info you'd have.

- the nurse lost the meds and needs another dose

Unless you typically give out entire new prescriptions based on the word of a nurse, then nothing changes here. Still need new Rx.


- the patient was prematurely D/Ced
Are we talking retail? Any pharmacist would still then be in the same position, you wouldn't not fill an Rx cause you thought theyre gonna bounce back to the hospital soon.

- the doctor could mess up the sig by writing the wrong dose/dosage form/frequency (the pharmacist who deals exclusively with the patient will instinctively know that this is wrong while an outsourced pharmacist who verifies one script for this patient won't have a clue unless they had the time to check a patient's chart for every script)

I'd assume they'd have the same access to computer information, if not then you're right but if they see the same profile (which they would have to for all DI's) then it's the same info for a rph in person.


- the patient is coding and needs medications sent up immediately

Ppl coding usually avail of crash carts on scene. They're pre-mixed/made. If an order is STAT then maybe.... there'd still be pharmacists in the hospital.

sorry couldn't elaborate more, gotta jet.

 

[SpirivaSunrise]

What the hell are y'all talking about? Pie in the sky indeed.
You still have to pay a pharmacist who sits at home. Duh! You can't just not pay someone, because you're outsourcing them. Therefore, your 3 mil investment in a machine will cost more like 3 mil plus X dollars times Y number of pharmacists who have to verify scripts plus their benefits and 401k, etc.

If patients were one-dimensional, then I would consider outsourcing at 100% to be very valuable. However, there are thousands of combinations that could pop up for a pharmacist to manage.
Just a few examples:
- the inventory counts may not be 100% legit
- the nurse lost the meds and needs another dose
- the patient was prematurely D/Ced
- the doctor could mess up the sig by writing the wrong dose/dosage form/frequency (the pharmacist who deals exclusively with the patient will instinctively know that this is wrong while an outsourced pharmacist who verifies one script for this patient won't have a clue unless they had the time to check a patient's chart for every script)
- the patient is coding and needs medications sent up immediately

The outsourced pharmacist would have no control over any of these parameters. Sure... they could verify what the script says, but they wouldn't be able to adjust for changes in follow-through.
*Outsourced pharmacists can't compound!

One more thing: doctors aren't going to want to deal with an outsourced pharmacist. It's the same principle with everything else. Think about what a pain in the *** mail order pharmacy is. Who likes talking to someone in India about their bank statements? People still want to talk to someone directly when they shop for groceries, clothes, cars, etc.

Well...think of how many hospitals one remote RPh can do order entry/verification for. When you add it all up, it's not 1:1. Cost savings would be huge. More importantly though, what I think some people are trying to get to is...it frees up a lot of pharmacists from doing the tedious (but still necessary) stuff. Leaves a bunch of pharmacists to do the "clinical" (there's that word again ) work. Maybe that's a scary thought to some?

Also...consider the joint commission's MM.4.10 standards (regarding prospective order review by a pharmacist) and how it relates to what Epic's proposing.

Here's a hint: http://www.ashp.org/emplibrary/RemoteOrderEntry.pdf

And here are the proposed revisions: http://www.jointcommission.org/Standards/FieldReviews/021908_mm410_fr.htm What do you know? You can still make comments about it up until Tuesday.

 

[PharmDstudent]

Well...think of how many hospitals one remote RPh can do order entry/verification for. When you add it all up, it's not 1:1. Cost savings would be huge. More importantly though, what I think some people are trying to get to is...it frees up a lot of pharmacists from doing the tedious (but still necessary) stuff. Leaves a bunch of pharmacists to do the "clinical" (there's that word again ) work. Maybe that's a scary thought to some?

Also...consider the joint commission's MM.4.10 standards (regarding prospective order review by a pharmacist) and how it relates to what Epic's proposing.

Here's a hint: http://www.ashp.org/emplibrary/RemoteOrderEntry.pdf

And here are the proposed revisions: http://www.jointcommission.org/Standards/FieldReviews/021908_mm410_fr.htm What do you know? You can still make comments about it up until Tuesday.

Frees up who? Someone still has to do data entry. That's why I proposed PharmA a while back.

Wags does remote verification for the initial data entry. However, it doesn't always work out. A lot of times, I have to get the pharmacist to verify what I've typed quickly so that another pharmacist across the state won't reject the initial entry.
Example: Doctor writes- Amoxil 400/5 one tea po bid X ten days #100. The pharmacy has #150 on hand. Tech types it for #150. Pharmacist on the other side of the state rejects it, because the quantity's too high.

I type scanned scripts for other stores too (lucky for them). I have no idea if that pharmacy actually has what I type in stock. I chose not to type controls or scripts that I think are too complicated, because I would never want to be named in a lawsuit.

Does it actually free anyone up if I type their scripts? No. I just keeps me busy. I actually enjoy it, because I get to see what other pharmacies are filling across the state.

I don't have Adobe right now, so I can't read the pdf file.

 

[PharmDstudent]

Don't forget about HIPPA. If a pharmacist is sitting at home doing data entry, then there's no way to guarantee that the patient's privacy is being protected.

 

[SpirivaSunrise]

Frees up who? Someone still has to do data entry. That's why I proposed PharmA a while back.

Wags does remote verification for the initial data entry. However, it doesn't always work out. A lot of times, I have to get the pharmacist to verify what I've typed quickly so that another pharmacist across the state won't reject the initial entry.
Example: Doctor writes- Amoxil 400/5 one tea po bid X ten days #100. The pharmacy has #150 on hand. Tech writes types it for #150. Pharmacist on the other side of the state rejects it, because the quantity's too high.

I type scripts for other stores too (lucky for them). I have no idea if that pharmacy actually has what I type in stock. I chose not to type controls or scripts that I think are too complicated, because I would never want to be named in a lawsuit.

Does it actually free anyone up if I type their scripts? No. I just keeps me busy. I actually enjoy it, because I get to see what other pharmacies are filling across the state.

I don't have Adobe right now, so I can't read the pdf file.

Alright...so lets say you've got a RPh doing order entry at hospitals all across LA: Olla, Tallulah, Ferriday, Shreveport, Winnfield, Bunkie, DeRidder, Luling...etc. Tiny hospitals...50 beds or less. If you were to combine all those accounts and have a remote RPh doing order entry/verification...do you still think it would take as many pharmacists? And what happens at night, when the pharmacy is closed?

 

[azPharmD2B]

I'm convinced we can't stop globalization . . .

50 state boards of pharmacy would disagree with you. Unless this can be overcome there will be no 'globalization'.

Some hospitals and mail order pharmacies already have pharmacists working from home doing order entry verification. I can certainly see a future where more and more of this type of work is distributed amongst large numbers of at home pharmacists. Image a company like CHW or Banner who have numerous 'individual' hospitals. Well, they can simply contract out the verification side of the pharmacy work. Based on forcasting you assign staffing for a baseline of work. Suppose there is a major fire/outbreak and suddenly the hospital is swamped. On-call at-home pharmacists receive a text message indicating that extra hours are available (obviously at a premium). They log in, sign-up for a certain number of scripts or hours, process the scripts, make some extra cash, everyone wins.

Why does this work? You can pay pharmacists less and offer them more schedule flexibility in return. Remember, the larger the pool of labor you have the easier it is to account for reasonable staffing fluctuations. Plus you can draw in pharmacists from areas with lower costs of living and pay them less than someone based in NYC or LA. The hospital saves money by better being able to adjust staffing costs. It also frees up valuable hospital floor space. I see this working for both hospital and mail order. As to retail, given my strong background in computer technology, I don't see any of the previously mentioned suggestions being feasable. Retail pharmacists make up a large percentage of total pharmacists, so I don't see any reason to be worried.

Don't forget about HIPPA. If a pharmacist is sitting at home doing data entry, then there's no way to guarantee that the patient's privacy is being protected.

HIPPA doesn't prevent patient's personal information from being divulged any more than laws against murder keep people from being murdered. HIPPA provides a set of guidelines to follow and punishments to be enacted against companies that fail to follow them. What does it matter if a pharmacist is sitting at home or at the hospital, they still have access to the same information. They still have the ability to plug in a flash drive and copy information, or print it out and walk away with it. Sure it may be slightly more difficult to do from the office, but not so much that a determined person would be the least bit deterred.

 

[PharmDstudent]

Alright...so lets say you've got a RPh doing order entry at hospitals all across LA: Olla, Tallulah, Ferriday, Shreveport, Winnfield, Bunkie, DeRidder, Luling...etc. Tiny hospitals...50 beds or less. If you were to combine all those accounts and have a remote RPh doing order entry/verification...do you still think it would take as many pharmacists? And what happens at night, when the pharmacy is closed?

Unless you can outsource to super-fast pharmacists that enjoy doing slave labor for lower pay, it would take the same amount of work and money. Someone still has to read the order and verify it. It may be beneficial during peak hours to have more pharmacists doing data verification. Since the orders are time sensitive, you can't just leave them until the pharmacy slows down at night (even though it would eliminate the need for more pharmacists at a given time).

If you increase the dose of ethanol, is it still eliminated at the same rate? Yes (zero-order). My point is that you have to increase productivity somehow. You would need more enzymes to eliminate the alcohol. You need more magic to get the scripts out. You would need an order-entry catalyst (excuse the catalyst pun).

I've heard of four of those places

You have to have people on site to make sure that the orders are "physically" accurate. Someone has to say, for sure, that KCL 10mEq is going up to the geriatric unit to Mrs. Smith for her 6pm dose. A remote pharmacist's role can only go so far.

They probably already have something in place for night time, like a med cabinet or doses that were sent up earlier in the day.

Personally, I hate Pyxis machines.
- It was physically exhausting to bend over and fill the lower pockets for 50 units.
- The drawers that have access to adjacent pockets are dangerous. Nurses would shove unit-doses of everything under the sun in there without checking to make sure that they put the med back into the correct pocket.
- Techs would miss-fill the drawers too.
- The Pyxis machines would get jammed, and they would malfunction.
Sure, it's easier than sending up individual doses all day long, but it's not nurse-proof or tech-proof by any means.

 

[PharmDstudent]

HIPPA provides a set of guidelines to follow and punishments to be enacted against companies that fail to follow them. What does it matter if a pharmacist is sitting at home or at the hospital, they still have access to the same information. They still have the ability to plug in a flash drive and copy information, or print it out and walk away with it. Sure it may be slightly more difficult to do from the office, but not so much that a determined person would be the least bit deterred.

When your wife walks into the living room and takes a glimpse at your computer, she sees the patient's information. Most likely, your wife is not part of that company nor does she have authorization from the patient to view their information.

 

[genesis09]

My law project was about remote verification. We had to come up with all these safety devices to ensure HIPAA compliance, and that the pharmacist would not log in at inappropriate times. There is a market for this, but I don't see a huge change in the demand for community or hospital pharmacists for this. Most pharmacies are already at the minimum required number of pharmacists.

 

[confettiflyer]

You like this topic don't you.

I'm a futurist at heart...I like coming up with off the wall/possibly realistic visions of what pharmacy will be like in the future.

I'm still waiting for the Jetson's style suitcase car.

 

[azPharmD2B]

When your wife walks into the living room and takes a glimpse at your computer, she sees the patient's information. Most likely, your wife is not part of that company nor does she have authorization from the patient to view their information.

I would think I would enlighten my wife to the sensitivity of my work long before I started working at home. But to use your terrible analogy, are there no computers in use in the ER? When a family member goes from the waiting room to the bedside of someone in the ER is every single computer locked down or a hood put over the head of the visitor? No, don't be stupid. Maybe you haven't heard but there are already pharmacists working from home with the blessing of the boards of pharmacy. They aren't quite the idiots you make them out to be.

Basic precautions exist to provide a basic level of intrusion prevention. Its no different than having a car alarm. A determined car thief can steal any car, just like a determined identity thief can find out everything about you.


As to future tech, I can't wait until we have something like that holo-doctor from Star Trek.

 

[confettiflyer]

I thought HIPAA violations had to be intentional or have reckless disregard for privacy? Giving someone the wrong Rx at the retail pharmacy by accident doesn't count as a HIPAA violation...but combing patient records for use in marketing is (hence the CVS settlement a while back).

 

[PharmDstudent]

I thought HIPAA violations had to be intentional or have reckless disregard for privacy? Giving someone the wrong Rx at the retail pharmacy by accident doesn't count as a HIPAA violation...but combing patient records for use in marketing is (hence the CVS settlement a while back).

We were taught in our introductory pharmacy class that any breech of privacy, meaning if anyone saw, overheard, or got access to another person's prescription information without authorization, could lead to punishment by law.
In addition to this website, maybe someone else on the forum could offer a little insight.

 

[Aznfarmerboi]

The punishment is based on criminal intent. If there is no intent, it really is hard for them to go after you.

 

[azPharmD2B]

We were taught in our introductory pharmacy class that any breech of privacy, meaning if anyone saw, overheard, or got access to another person's prescription information without authorization, could lead to punishment by law.
In addition to this website, maybe someone else on the forum could offer a little insight.

lol, you either had an idiot professor or misunderstood what they said.

http://www.hhs.gov/hipaafaq/limited/196.html

You need to take reasonable precautions to ensure patient privacy. People need to be trained on those processes. A single individual is accountable for ensuring that the processes are followed and the people are trained.

 

[confettiflyer]

Yeah I was about to say...I was under the impression that malice aforethought is prerequisite to any punishment under HIPAA.

 

[azPharmD2B]

Yeah I was about to say...I was under the impression that malice aforethought is prerequisite to any punishment under HIPAA.

That or negligence in taking reasonable precautions.

In a retail setting, a reasonable precaution are those little stop signs asking the next person in line to wait a little further back to respect the privacy of the person at the window. A reasonable precaution is ensuring that all entrances to the pharmacy have security measures in place and that patient records are kept secure. A reasonable precaution when someone calls to check on a prescription is that you verify the persons identity before giving out any personal information.

In a hospital setting its ok for two employees to discuss a patient at a nurses station because it is considered semi-private. A reasonable precaution would be to make sure people lock their computer workstation before leaving their desk. A reasonable precaution is shredding all paperwork that has patient information on it.

Keyword is reasonable. If the company doesn't have reasonable precautions in place they can be held accountable. If an individual purposely violates company policies the individual can be prosecuted and the company is safe.

 

[PharmDstudent]

lol, you either had an idiot professor or misunderstood what they said.

Why do you make judgments about people instead of just trying to state your point? It makes you look like a jerk. Maybe that's what you want. Who knows?

 

[azPharmD2B]

Why do you make judgments about people instead of just trying to state your point? It makes you look like a jerk. Maybe that's what you want. Who knows?

Because anyone who words things to be all inclusive and definitive is an idiot.

We were taught in our introductory pharmacy class that any breech of privacy . . .

That's just dumb. You don't word it that way. What if super secret ninjas snuck into CVS at night, after hacking the alarm system, picking the lock on the front door and the pharmacy door, knocking out the security guard with a Vulcan neck pinch and then took pictures of your prescription. Do you seriously think CVS would be found in violation of HIPAA guidelines?

Common sense should dictate your professor was full of it. Pharmacists don't provide patient counseling in a sound proof booth with mirrored windows. Obviously if tens of thousands of pharmacists were breaking the law hundreds of times a day we would have heard about it and things would be different.

 

[PharmDstudent]

Because anyone who words things to be all inclusive and definitive is an idiot.

Calling someone an idiot is all inclusive and definitive, Yo!