September 17, 2008
AP photo - Kathy Nelson, owner of the pharmacy in Arthur, N.D., demonstrates the computer and camera that pharmacy technicians use to communicate with pharmacists on prescriptions. Aug. 31.
ARTHUR, N.D. — As recently as three years ago, many elderly residents in this part of southeastern North Dakota were forced to order their medications by mail.
These days, customers have a real drugstore and can talk to a real person about their health needs — albeit via the Internet.
Thanks to the virtual pharmacy system that has been tested on the frozen prairie, the days of walking down to the general store for prescription drugs are returning to rural America.
"It's perfect," said Jim Williams, a longtime Arthur resident. "You can walk down there and it's done in a few minutes."
Most telepharmacies are staffed with registered pharmacy technicians, who usually need about two years of schooling and earn about $15 an hour in North Dakota. Some registered nurses also have been trained for the job.
The pharmacy technicians use remote cameras to contact pharmacists in another location and show them the original signed prescription, computer-generated label, stock bottle where the pills are stored and the bottle the patient will take home. Once the prescription is approved, patients have a mandatory private consultation with pharmacists through real-time video and audio.
"We can do most of the things the pharmacists do except give professional advice," said Jennifer Joyce, the pharmacy technician in Arthur. Joyce knows all of her patients on a first-name basis.
"You don't have the expense of a regular pharmacist," said Katie E. Thompson, a registered pharmacist who lives near Page. "That's the point of a telepharmacy."
North Dakota lawmakers opened the door for the telepharmacy project by passing legislation in 2001, after dozens of rural pharmacies went out of business. The project began with 10 volunteer sites in 2002 and has grown to 67 locations.
The idea is catching on in other places.
States that have changed laws to allow for remote pharmacies include Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont and Wyoming, along with the District of Columbia. More are on the way, according to the leader of North Dakota's project.
"We get calls every day from other states," said Ann Rathke, director of telepharmacy at North Dakota State University in Fargo. "A lot of states have used or have adopted in some way our rules, because they were out there."
Charles Peterson, dean of pharmacy at NDSU, said the rest of the country has been "watching and waiting" to see how the North Dakota project worked.
"Every state is struggling with, for the most part, the same issues," he said. "Access to health care in a rural setting is a problem for everyone. We have shown that this is a solution."
Rathke said it costs about $18,000 to set up a site in North Dakota, including equipment, installation and one year of Internet service. Telepharmacies pay an annual licensing fee of $175.
In most cases, pharmacy has more laws and rules than any other area of health care and many states are unwilling to make modifications or adjustments, Peterson said.
"Those other states that haven't in some cases been willing to talk about it, willing to even look at it, are being forced to look at it because North Dakota has proven this thing," Peterson said.
The first telepharmacy in Texas opened in 2002 in the town of Turkey, but only a few more have popped up since then, said Debbie Voyles, director of telemedicine at Texas Tech University.
"Where there are no pharmacies, there are no doctors," she said. "Patients have to travel to see the doctors, so it's no big deal to them to have to pick up the prescriptions."
The Texas Tech pharmacy school is looking at ways to increase interest and is hoping to learn from North Dakota's success, Voyles said.
Don Turner, who runs the virtual pharmacy in Turkey, said his clients are mostly elderly people who don't have access to transportation. The nearest pharmacist to the town of 400 people is about 50 miles away.
"It's a great thing for Turkey," Turner said. "I think it's just a matter of time for other small towns."