Supporting Rural Hospitals with Telehealth

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How telepharmacy helps facilities keep their doors open

In today’s tough healthcare economy, many healthcare executives unfortunately view rural hospitals as obsolete because of the costs associated with remaining viable in the challenging healthcare environment. However, one in six Americans currently lives in a rural county, showing that these facilities are essential in providing quality healthcare to a sizable portion of the overall patient population.1 As the American demographic shifts to a larger population of elderly individuals with an increasing number of high-need patients, supporting these rural hospitals and keeping them working efficiently should be a high priority in our health system.

Just because someone chooses to live in a rural area shouldn’t mean they receive a lesser quality of healthcare because of geography. Telehealth solutions, specifically telepharmacy, are uniquely suited to address some of the key challenges these facilities face in keeping their doors open for patients. By extending existing resources and clinical expertise, this technology helps provide better care for patients without negatively affecting an organization’s bottom line.

As of March 2016, there are 1,855 rural hospitals operating in the U.S., with 1,330 of these categorized as critical access hospitals (CAH), which have an average patient census of 5.7 per day.2 This level of patient load is leading hospital administrators and the C-suite to explore technology innovations that ensure the quality of care necessary to remain open for patients.

Extending Financial Resources

According to the National Rural Health Association, 683 rural hospitals are vulnerable to closures, and 35% of all rural hospitals operate at a financial loss.3 For these facilities, properly managing budgets and extending financial reach without reducing clinical quality is imperative.

As an alternative to paying for a full-time employee in the pharmacy during these non-peak hours, which is often not a realistic option, telepharmacy can be used to cover night and weekend shifts when the number of prescriptions for review may taper off. This ensures medication orders are properly reviewed at all times, regardless of prescription volume, promoting enhanced patient safety and lowering the risk of adverse events. Additionally, telepharmacy prevents on-site pharmacists from having to review a stack of medication orders when they come in the next morning, so they are able to launch into that day’s activities instead of backtracking.

From a financial perspective, having a pharmacist verify medication orders remotely or provide counseling via the phone or video to providers allows hospitals to share the labor of one clinical pharmacist, and therefore the cost. The volume of prescriptions is often lower during non-business hours, making it impractical to staff an FTE to sit in the pharmacy and wait for orders to arrive. Instead, a remote pharmacist can work multiple locations when their order volumes are lower, providing the same clinical excellence as an on-site pharmacist while covering multiple sites.

Access to Clinical Expertise

In addition to extending the labor dollars of hospitals operating at narrow margins, telepharmacy also helps provide enhanced clinical expertise and specialized care to rural areas. Rural regions may have a lack of diversity when it comes to clinical specialists, as these individuals are often attracted to urban hospitals with higher patient volumes. Having access to a specialized clinical pharmacist, either during non-peak hours or ‘normal’ 9-5 business shifts, allows rural hospitals to ensure they are offering the highest level of clinical care to patients. These experts often focus on pediatrics or oncology, where their additional expertise is crucial to answering difficult care or dosing questions.

As polypharmacy, or taking five or more medications concurrently, becomes more common, so do medication interactions that can be dangerous for patients.4 By bringing in additional clinical support, on-site pharmacists can become more involved in patient-facing activities such as medication reconciliation at the point of admission or discharge. Other activities that benefit from a pharmacist as part of the care team include decisions about medication treatment plans, discharge planning, and follow-up care.

Supporting Technology Implementations

As hospitals begin to be rewarded for providing value-based care that improves patient outcomes, patient-centered initiatives such as discharge planning are becoming increasingly common. While rural hospitals don’t face the same requirements as urban facilities, providers across the entire country are being pushed to deliver services that provide excellent care and improve long-term outcomes– regardless of their patients’ location.

As part of this process, hospitals in both urban and rural areas are seeking to better understand health information technology and how their services can help streamline operations while improving care. However, when implementing these technologies, proper clinical support and workflows must be considered. As an example, a recent report showed that computerized physician order entry (CPOE) systems failed to flag 13% of potentially fatal medication orders.5 This type of situation can occur when hospitals install a new technology, and then think it will run itself; this study illustrates this is clearly not the case.

Case in point, when orders come in during evening hours or when an on-site pharmacist may not be working, orders processed through CPOE get transmitted directly to the cabinet where nurses can override for the medication. Having a pharmacist reviewing orders at all times helps to prevent these medication errors, which are often caught during standard checks performed by a telepharmacist. Even when reviewed off-site, having a set of clinically trained eyes on medication orders adds another level of security and safety for patients and providers.

All is not lost for rural hospitals, however. Technologies like telepharmacy and telehealth video consultations continue to grow in popularity, offering affordable solutions that enable under-resourced facilities to provide leading care to their valued patients. Legislative efforts are also attempting to lessen the burden on these facilities, recognizing the central role they play in treating America’s rural communities.6 These legal efforts, combined with innovative technology properly supported by clinical expertise, can help ensure these facilities stay open and support rural patients who often need these services the most.

References

  1. Commins, J. “Rankings Illustrate Health Challenges for Rural America,” Health Leaders. March 23, 2016. http://www.healthleadersmedia.com/community-rural/rankings-illustrate-health-challenges-rural-america
  2. Rappleye, E. “5 areas of healthcare ripe for disintermediation,” Becker’s Hospital Review. March 30, 2016. http://www.beckershospitalreview.com/hospital-management-administration/5-areas-of-healthcare-ripe-for-disintermediation.html
  3. Bryant, M. “Rural hospitals keep closing. What can be done?” Healthcare Dive. March 22, 2016. http://www.healthcaredive.com/news/rural-hospitals-keep-closing-what-can-be-done/416038/
  4. Span, P. “The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills,” New York Times. April 22, 2016. http://www.nytimes.com/2016/04/26/health/the-dangers-of-polypharmacy-the-ever-mounting-pile-of-pills.html?_r=0
  5. Landi, H. “Report: CPOE Systems Failed to Flag 13 Percent of Potentially Fatal Medication Orders,” Healthcare Informatics. http://www.healthcare-informatics.com/article/report-cpoe-systems-failed-flag-13-percent-potentially-fatal-medication-orders
  6. Bryant, M. “Rural hospitals keep closing. What can be done?” Healthcare Dive. March 22, 2016. http://www.healthcaredive.com/news/rural-hospitals-keep-closing-what-can-be-done/416038/
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About Author

Brian Roberts
Brian Roberts

CEO of PipelineRx. He has spent most of his career focused on healthcare services and staffing. Prior to co-founding PipelineRx, a telepharmacy company in 2009, he was the president of Canopy Healthcare until it was acquired in late 2008. Canopy Healthcare was an allied healthcare staffing firm on the West Coast. Prior to Canopy Healthcare, Roberts was the EVP of business development at CHG Healthcare Services, a $600 million leader in diversified healthcare staffing, which supplied physicians, pharmacists, nurses and allied healthcare professionals to hospitals nationwide. Roberts holds an MBA from Boston University and an AB in Economics from Dartmouth College. PipelineRx is a nationwide company headquartered in San Francisco and has over 150 employees.

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